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Regional perspectives on preventing alcohol-related road crashes involving vulnerable road users w www.icap.org e info icap.org 0 Welcome from UNECE and ICAP Welcome from UNECE and ICAP Dear Reader The United Nations Economic Commission for Europe (UNECE) and the International Center for AlcoholNations Economic Commission for bring you this e-book. It International Center for our The United Policies (ICAP) are delighted to Europe (UNECE) and the is the key outcome of collaboration on an international symposium on Regional perspectives on preventing alcoholAlcohol Policies (ICAP) are delighted to bring you this e-book. It is the key outcome of our related road on an international symposium Regional perspectives onthe opening event of the collaboration crashes involving vulnerable road users which was preventing alcohol-related United Nations Global Road Safety Week inwhich was Switzerland event of12 May 2013. road crashes involving vulnerable road users Geneva the opening on 6 - the United Nations Global Road Safety Week in Geneva Switzerland on 6 - 12 May 2013. Dear Reader Launched by the Executive Secretary of the UNECE Sven Alkalaj and Permanent Launched by the Executive Secretary of Netherlands to Alkalaj and Permanent Representative Representative of the Kingdom of thethe UNECE Sven the United Nations His Excellency of the Kingdom of the Netherlands to the United Nations cast a spotlight on alcohol-related Roderick van Schreven the international symposium His Excellency Roderick van Schreven the international symposium cast users such alcohol-related cyclists and motorcyclists. impacts on vulnerable road a spotlight onas pedestrians impacts on vulnerable road users such as pedestrians cyclists and motorcyclists. This e-book which is the first of its kind for the UNECE Transport Division and ICAP comprises Thiscomplete findings presentedkind for the UNECE Transport Division and symposium by road e-book which is the first of its in preliminary form at the international ICAP comprises the the complete findings presented world. safety experts from around thein preliminary form at the international symposium by road safety experts from around the world. The experts whose work follows are Mr. Eric Howard (global overview with Australian case The experts whose work follows are Mr the Middle East) overview with Australian Karlovsek studies) Mr. Michael Cale (Israel andEric Howard (global Professor Majda Zoreccase studies) and Central Asia) Dr. and the Middle East) Ms MajdaAfrica) and Professor Shaw Voon (Europe Mr Michael Cale (Israel Wilson Odero (Sub-Saharan Zorec Karlovsek (Europe and Central Asia) Mr Wilson Odero (Sub-Saharan unique information Voon Wong (Malaysia). We believe that their papers contain Africa) and Mr Shaw and insights and Wong (Malaysia). We believe that their papers contain unique information and insights and effective we hope that the policies and ideas contained here will lead to more enlightened and we hope that policies and the policies and ideas contained here will lead to more enlightened and effective practices in preventing drink driving and saving lives on the world s roads. policies and practices in preventing drink driving and saving lives on the world s roads. UNECE plays regional and global roles in reducing road fatalities and injuries through the UNECE plays regional and global roles in reducing road fatalities and injuries through the promotion of UN legal instruments on traffic rules vehicle regulations infrastructure promotion of UN legal instruments on traffic rules vehicle regulations infrastructure standards and sharing of of best practices. part part of effort UNECE is working in and sharing best practices. As As of this this effort UNECE is working in standards partnershipwith ICAP toto draw greater attention toimportance of drink drivingdriving interventions partnership with ICAP draw greater attention to the the importance of drink interventions in road safety efforts particularly in low- andand middle-income countries.works to foster foster in road safety efforts particularly in low- middle-income countries. ICAP ICAP works to dialogueand partnerships in in the alcohol policy field is committed to helping develop dialogue and partnerships the alcohol policy field and and is committed to helping develop pragmaticand feasible solutions to reducing alcohol-related harm.harm. pragmatic and feasible solutions to reducing alcohol-related Thank you for taking the time to read thisthis e-book.hopehopeyou will join usjoin usmission mission Thank you for taking the time to read e-book. We We that that you will in our in our to combinelocal knowledge and global best practices in transforming the world sworld s roads and to combine local knowledge and global best practices in transforming the roads and making them safer for everyone particularly the most vulnerable among us. us. making them safer for everyone particularly the most vulnerable among Sincerely Sincerely Ms Eva Molner Ms Eva Molnar Mr Brett Bivans Mr Brett Bivans Director UNECE Director UNECE Transport Division Transport Division 2 Senior Vice President Senior Vice President ICAP ICAP We DRIVE BY THERULES w www.icap.org e info icap.org 0 Contents Please click a section to view Contents Please click a section to view Road Saf ety Message f rom the UN Secretar y General Mr Ban Ki-Moon p le a se c l i c k to vi e w me s s a g e Pa c i f i c regiona l exp er t Mr Eric Howard p le a s e c l i c k to r e a d t h i s p a p e r Asia Asia rregionall expert t egiona exper Mr o r S h a w V Wong P r o f e s s Shaw Voon o o n Wo n g please click to read this p a p e r p l e a s e c l i c k t o r e a d t h i s pap er Africa Af r i c a rregional e x p e r t e g i o n a l expert Mr Wilson Odero D r Wilson Odero p lease click o e a d h i s paper p l e a s e c l i c k tto rread tthis p a p e r The views expressed in the following papers are those of the authors and not necessarily those of the UNECE or ICAP . This e-book has been issued without formal editing. 4 Europe Europe regiona exp er regionall exper t P r oMss s o r M a jZorec rKarlovseks e k f e Majda d a Z o e c K a r l o v p l e a s e c l i c k t o r e a d this paper please click to read t h i s p a p e r Middle East regiona l exp er t Mr Michael Cale p le a s e c l i c k to r e a d t h i s p a p e r Excerpts from t he Symposium pl e a s e c l i c k t o v i e w Pledge p l e a s e c li c k t o re a d our pl e d g e Conclusion pl e a s e c l i c k t o r e a d ou r c o nc l us i on w www.icap.org e e info icap.org 0 Road safety message from the UN Secretary-General Mr Ban Ki-Moon This road safety message was given on the occasion of the United Nations Global Road Safety Week 6-12 May 2013. 6 Watch the message from UN Secretary-General Ban Ki-Moon w www.icap.org e info icap.org 0 Regional Perspectives on on Preventing Regional Perspectives Preventing Alcohol-Related Road Crashes Involving Alcohol-Related Road Crashes Involving Vulnerable Road Users An Introduction Vulnerable Road Users An Introduction Alcohol is a significant part of the cultural fabric of many societies. There is of course considerable diversity of drinking patterns between countries and changes in those patterns have occurred (and will continue to occur) over time. While alcohol has been consumed in a number of forms in several societies as part of traditional and cultural events today alcohol is a regular part of a modern lifestyle in many societies. Mobility and mobility patterns have changed dramatically over the past century. People are increasingly mobile and this has encouraged expanded social interactions and changed working opportunities and patterns. These changes in themselves have also affected patterns of alcohol consumption in many societies. Mr Howard EricEric Howard Principal Whiting Moyne Consulting Email e r i c . h o w a r d b i g p o n d . c o m Western Pacific The motor vehicle is a part of the modern household in most societies. The ensuing challenges arising from this increased vehicle operation and use include an increased risk of alcohol-related road crashes. How can society foster the development of a culture that does not tolerate or enable foster the development of a culture that does not tolerate or enable drinking and driving or riding that discourages drink walking and that implements or riding that discourages drink walking and that implements measures (both voluntary and mandatory) to provide the opportunity for the public voluntary and mandatory) to provide the opportunity for the public to consume alcohol in moderation but not to drive or ride or walk on roads while alcohol in moderation ride or walk on roads while impaired by alcohol impaired by alcohol Our authors will provide some regional and national perspectives on this issue in their papers. It is and will remain a major challenge for safe road use globally. 8 Fatalities and Serious Injuries for VRUs Globally Fatalities and Serious Injuries for VRUs Globally In introducing the topic of regional perspectives on preventing alcohol-related road In introducing the vulnerable road perspectives on preventing alcohol-related road crashes involving topic of regional users let us start by considering the road crash crashes involving vulnerable road users let for vulnerable road users (VRUs)crashthe fatality and serious injury situation globally us start by considering the road and fatality and serious injury situation globally for vulnerable crashes are the eighth leading likely impacts of alcohol on those fatalities.Globally roadroad users (VRUs) and the likely impacts of alcohol on those fatalities. cause of death for the entire population and the leading cause of death for 15 29-yearolds (WHO 2013). More than a million people die each year on the world s roads and Globally road crashes are the eighth leading cause of death for the entire population and the cost of dealing with the consequences of road traffic crashes runs to billions of the leading cause of death for 15 29 year-olds (WHO 2013). More than a million people dollars each year. die each year on the world s roads and the cost of dealing with the consequences of road traffic crashes runs to billions of dollars each year. WHO (2013) estimates that by 2030 road traffic deaths will become the fifth leading cause of death unless urgent action is taken. WHO (2013) estimates that by 2030 road traffic deaths will become the fifth leading cause of death unless urgent action is taken. Half of the world s road traffic deaths occur among vulnerable road users including motorcyclists (23%) pedestrians (22%) and cyclists (5%). Half of the world s road traffic deaths occur among vulnerable road users including motorcyclists (23 per cent) pedestrians (22 per cent) and cyclists (5 per cent). The proportion of overall fatalities for each these three categories of vulnerable road The proportion of overall fatalities for each of countries categories of vulnerable road users vary substantially between regions andthese threearound the globe including users vary substantially between regions and countries around the globe including between high-income countries (HICs) and low- and middle-income countries (LMICs). between high-income countries (HICs) and low- and middle-income countries (LMICs). For example in selected regions of the world road crash fatalities involving VRUs For example in selected regions of the world road crash fatalities involving VRUs account for the following percentages of all road crash fatalities 1 1 account for the following percentages of all road crash fatalities Region and Country HIC Victoria Australia LMICs Africa LMICs Southeast Asia and Western Pacific LMIC East Java Indonesia % Pedestrian Fatalities 17 38 N A 24 % 2- and 3Wheeler Fatalities 17 N A 36 50 % Cyclist Fatalities 2 N A N A N A % Total VRUs 36 50 50 74 We must identify and consider what factors in each country or region contribute to this high incidence globally of serious road crash casualties involving VRUs. the adequacy of policies and legislation that are in place to It is instructive to review the adequacy of policies and legislation that are in place to address VRU crash risks. Only 28 countries representing 7 per cent world s population address VRU crash risks. Only 28 countries representing 7% of the of the world s population have adequate laws addressing all five key road user behavior risk factors (speed drink adequate laws addressing all five key road user behavior risk factors (speed drink driving helmets seat belts and child restraints). Less than 35% of cent of have policies in driving helmets seat belts and child restraints). Less than 35 per LMICs LMICs have policies in place to protect pedestrians and cyclists (WHO 2013). place to protect pedestrians and cyclists (WHO 2013). 1 From author s practitioner involvement and other contributors papers. w www.icap.org e info icap.org 0 Alcohol Involvement in VRU Crashes Alcohol Involvement in VRU Crashes Can the contribution of alcohol to serious crashes be determined The detail of this involvement will be complex reflecting the varied nature of the particular alcohol issues affecting VRU crashes in each country which in turn respond to the culture of alcohol use in each society. To better understand alcohol involvement as a crash factor for vulnerable road users it will be useful to categorize pedestrian cyclist and motorcyclist fatalities as follows drivers (for VRU-involved crashes where the driver was alcohol Drivers (for VRU -involved crashes where the driver was alcohol impaired impaired) Riders (for single-motorcycle or other VRU-involved crashes where the or riders (for single-motorcycleandother VRU-involved crashes where the rider was alcohol impaired) rider was alcohol impaired) and Pedestrians or cyclists who were alcohol impaired pedestrians or cyclists who were alcohol impaired. When an assessment of the incidence of the related fatal crashes by category of crash and number can be made attention can turn to applying proven solutions to address the identified problems. Understanding the Problem A Focus on Understanding the Problem A Focus on Alcohol-Impaired Pedestrian Crashes Alcohol-Impaired Pedestrian Crashes Examining alcohol involvement in all VRU-related fatal and serious injury crashes is beyond the scope of this introductory paper. However to give an indication of the approach necessary to determine the contributing factors to these alcohol-involved crashes for VRUs the situation for pedestrians is summarized below. What are the risk factors associated with alcohol-impaired serious pedestrian crashes and when and where are they occurring A two-part study A two-part study of alcohol-impaired pedestrian crash pedestrian crash involvement (consisting of an international literature (consisting of an international literature review and a study of coronial records review and a study of coronial records in Australia) conducted by Cairney and in Australia) conducted by Mr Cairney and colleagues (2004) provides interesting colleagues (2004) provides interesting insights into the issue for HIC environments. insights into the issue for HIC According to the review accident risk for environments. According to the review intoxicated pedestrians appeared lower at accident risk for intoxicated pedestrians traffic controls even though intoxicated appeared lower at traffic controls even pedestrians did not though intoxicated pedestrians did not 10 use them correctly. Further high-BAC crashes (i.e. where the pedestrian blood alcohol use them correctly. Further high-blood alcohol content (BAC) crashes (i.e. where the pedestrian blood than 150 mg 100 ml) were than 150 mg 100 content was greateralcohol content was greater associated with ml) were associated with Near-side crashes (67%) Near-side crashes (67 per cent) Weekends (52%) Weekends (52 per cent) Hours between 6 p.m. and 6 a.m. (78(78%) Hours between 6 p.m. and 6 a.m. per cent) Close proximity (within 400 m) m)licensed premises (70 per cent) and Close proximity (within 400 to to licensed premises (70%) Inner suburban areas (56 per cent). Inner suburban areas (56%). Foss et al. al. (1997) contended that rather than attempting to modify pedestrian behavior Foss et (1997) contended that rather than attempting to modify pedestrian behavior it is likely to more useful to aim countermeasures at drivers. This would require better it is likely to bebe more useful to aim countermeasures at drivers. This would require better information about situational factors characterizing impaired-pedestrian This information about situational factors characterizing impaired-pedestrian collisions. collisions. time lighting visibility lighting visibility road type and condition location could includeThis could include time road type and condition location pedestrian pedestriandriver actions.driver actions. actions and actions and Mr Cairney et al. (2004) also that that the time of day is a prime predictor of the Cairney et al. (2004) also foundfoundthe time of day is a prime predictor of the incidence incidence of drinking pedestrians (in areas of high pedestrian flow) relative the relative of drinking pedestrians (in areas of high pedestrian flow) and that theand that fatalfatalaccident risk for male pedestrians with aaboveabove 100 mg 100 ml (0.10) is accident risk for male pedestrians with a BAC BAC 100 mg 100 ml (0.10) is significantly higher than non-alcohol-affected male pedestrians. significantly higher than forfor non-alcohol-affected male pedestrians. It also reported that countermeasures address alcohol-impaired pedestrian crash risk It also reported that countermeasures to to address alcohol-impaired pedestrian crash risk may besuccessful by adopting a publicpublic health approach rather focusing on may be more more successful by adopting a health approach rather than than focusing on road crashes only and that this approach could be used to pilot initial road crashes only and that this approach could be used to pilot initial solutions. It is solutions. It is recommended that if a jurisdiction has no data the course of action recommended that if a jurisdiction has no data the course of action should be a focus should be a focus on addressing VRU fatal and serious-casualty crashes generally. on addressing VRU fatal and serious-casualty crashes generally. Importance Data - - Case Study from Importance of of data Case Study from New South Wales Australia NSW Australia Trend Data Pedestrian Serious Casualties Trend Data forfor Pedestrian Serious Casualties Use of trend data is a highly important tool for practitioners and researchers. It enables Use of trend data is a highly important tool for practitioners and researchers. It enables changes over time in road trauma components to be monitored and understood and changes over time in road trauma components to be monitored and understood and compared with measures applied over a certain time period (plus a certain lag period) compared with measures applied over a certain time period (plus a certain lag period) often enabling impacts to be detected even before scientific review can be carried out. often enabling impacts to be detected even before scientific review can be carried out. Of course full evaluation of interventions should be conducted as much as possible. Of course full evaluation of interventions should be conducted as much as possible. An example of the usefulness of trend data is evident in pedestrian fatality data drawn An example of the usefulness of trend data is evident in pedestrian fatality data drawn from the Centre for Road Safety in New South Wales (NSW) Australia. The data show from the Centre for Road Safety in New South Wales (NSW) Australia. The data show that from a peak of 367 fatalities in 1960 pedestrian fatalities fell by 86 per cent. (There that from a pedestrian fatalities on NSW roads in 2010 the equal second lowest annual were 59 peak of 367 fatalities in 1960 pedestrian fatalities fell by 86%. (There were 59 total since records began in 1928). in 2010 the equal second lowest annual total pedestrian fatalities on NSW roads since records began in 1928). w www.icap.org e info icap.org 0 Linking Pedestrian Casualties to Travel Speeds (As Determined by Speed Limits) in NSW Travel speed of vehicles is a key determinant of risk for vulnerable road users. Data show that one-third of all pedestrian fatalities in NSW occur on roads with a posted speed limit in excess of 60 km h but nearly two-thirds of all injuries occur on roads with a posted speed of 50 km h or less. Understanding the Effects of Traffic Controls on Pedestrian Crash Involvement Traffic control measures assist safe road use. Most pedestrian casualties in NSW occur at locations without some form of pedestrian control present. The Role of Alcohol Impairment in Pedestrian Casualties In at least 30 per cent of pedestrian fatalities 30% of pedestrian fatalities and 8% of per cent of pedestrianNSW from NSW and 8 pedestrian injuries in injuries in 2006 from 2006 to 2010 the a BAC level of 50 to 2010 the victim had victim had a BAC level of 50 mg 100 ml (0.05) or more. However mg 100 ml (0.05) or more. However alcohol alcohol levels are unknown for two-thirds of levels are unknown for around around twothirds of all pedestrian Where alcohol results all pedestrian injuries. injuries. Where alcohol results are the pedestrian had a had level are known known the pedestrian BAC a BAC level of 50 mg 100 ml (0.05) or higher in 33 of 50 mg 100 ml (0.05) or higher in 33% of per cent of pedestrian fatalities and 24 per pedestrian fatalities and 24% of pedestrian cent of pedestrian injuries. injuries. 12 This sample of available data on This sample of available data on pedestrian crashes from NSW pedestrian crashes from NSW represents good practice in data represents good practice in data collection as the basis for analysis and collection as the basis for analysis and understanding of pedestrian seriousunderstanding of pedestrian serious crash involvement and some of the crash involvement and some of the various contributing factors to that various contributing factors to that outcome. It provides a basis for further outcome. It provides a basis for further review to determine other contributing review to determine other contributing factors. All jurisdictions need to factors. All jurisdictions need to develop (and enhance over time) crash data systems as soon develop (and enhance over time) crash data systems as soon as possible to support such support such an evidence-based as possible to an evidence-based approach. approach. Understanding Available Research Understanding Available Research and Commissioning Local Research and Commissioning Local Research In considering pedestrian fatalities and pedestrian BAC levels the Cairney et al. In considering pedestrian fatalities and pedestrian BAC levels the Cairney et al. (2004) review of studies (mostly from high-income countries) provided the following (2004) review of studies (mostly from HICs) provided the following outcomes outcomes More than per cent fatally injured adult pedestrians have a BAC level More than 25 25% of of fatally injured adult pedestrians have a BAC level exceeding 80-100 mg 100 exceeding 80-100 mg 100 ml. ml. The distribution of impaired pedestrian BACs is skewed towards The distribution of impaired pedestrian BACs is skewed towards higher BACs. higher BACs. The victims are predominantly male. The victims are predominantly male. The incidence of alcohol-related pedestrian crashes is related to The incidence of alcohol-related pedestrian crashes is related to social social deprivation which is particularly evident among indigenous deprivation which is particularly evident among indigenous people. people. In examining In examining pedestrian crash involvement and BAC levels Mr Struik and involvement and BAC levels Struik and Rogerson Mr Rogerson (1988) (1988) found that found that Pedestrians with a BAC greater thanmg 100 ml had doubledouble the Pedestrians with a BAC greater than 100 100 mg 100 ml had the risk of being involved in a crash compared with those with a BAC less risk of being involved in a crash compared with those with a BAC less than 100 mg 100 ml. ml. than 100 mg 100 Those with a BAC greater thanmg 100 ml had 15 times the riskthe risk Those with a BAC greater than 150 150 mg 100 ml had 15 times of of being injured in a crash compared to those with a BAC less than being injured in a crash compared to those with a BAC less than 100 mg 100 ml. 100 mg 100 ml. These important findings are generally consistent with other international studies. w www.icap.org e info icap.org 0 Summary Understanding VRU Crash Risks and Summary Understanding VRU Crash Risks and Alcohol Involvement Alcohol Involvement It is obviously crucial to establish data systems and to collect data about fatal and to establish data systems and to collect data about fatal and serious-injury crashes involving VRUs and the levels of alcohol impairment crashes involving VRUs and the levels of alcohol impairment associated with the drivers riders pedestrians and cyclists in thosethose crashes. the drivers riders and pedestrians and cyclists in crashes. It will also be useful to know the locations and nature of these crashes and the to know the locations and nature of these crashes and the circumstances including travel speed associated with each. including travel speed associated with each. Achieving comprehensive and uniform testing for alcohol and drug impairment comprehensive and uniform testing for alcohol and drug impairment levels in the blood supply of all pedestrian motorcyclist and cyclist crash victims supply of all pedestrian motorcyclist and cyclist crash victims presenting at hospitals presents a substantial challenge for LMICs. hospitals presents a substantial challenge for LMICs. There are fundamental public-sector management and resourcing issues to be fundamental public-sector management and resourcing issues to be addressed here. To understand the contribution of alcohol impairment to these To understand the contribution of alcohol impairment to these serious-casualty crashes implementation of blood testing has to be aa key mediumcrashes implementation of blood testing has to be key medium term goal for road safety agencies in these countries. term goal for road safety agencies in these countries. Identifying Potential Solutions to Reduce VRU Potential Solutions to Reduce Serious Casualties VRU Serious Casualties All countries have opportunities to make gains in reducing VRU All countries have opportunities to make gains in reducing VRU serious casualties generally including those involving alcohol serious casualties generally including those involving alcohol impairment of road users. In determining solutions ititwill be impairment of road users. In determining solutions will be helpful to focus on the five safe system pillars of the UN Decade helpful to focus on the five safe system pillars of the UN Decade of Action road safety management safer roads and mobility management safer roads and mobility (speeds) safer vehicles safer road user behavior and post(speed) safer vehicles safer road user behavior and postcrash emergency care. crash emergency care Road Safety Management Road Safety Management This pillar emphasizes the importance of working across sectors to understand crash risks and safe system principles and to develop and deliver interventions. It applies to crash data analysts infrastructure designers footpath and roadside markets managers bus services operators and public regulators deterrence officers (legislation and enforcement) public education officers emergency medical care and hospital treatment practitioners (plus BAC recording) and others. It requires that agencies work with the alcohol industry at a senior level to explore options for reduced alcohol-impaired fatal and serious-crash outcomes for all road users including VRUs. Safer Roads (Infrastructure) and Mobility (Speed) Safer Roads (Infrastructure) and Mobility (Speeds) Solutions within this pillar include road safety audit processes (for proposed roads) to detect safety shortcomings within road designs before they are constructed-- ensuring that the process assesses safety for all road users including all VRUs. 14 Applying higher-level safe system Applying higher-level safe system principles to existing roads through principles to existing roads through International Road Assessment International Road Assessment Programme (iRAP) safety assessments Programme (iRAP) safety assessments (which provide star ratings for roads based (which provide star ratings for roads based on the assessed safety performance using on the assessed safety performance using video recording and processing of road video recording and processing of road and road-environment data) is an and road-environment data) isbecome important approach that has an important approach that has become available in the last five or so years. available in the last five or so years. crash Options for treatments to lower injury risk are also generated. lower which is a Options for treatments to iRAP injury crash registered charity dedicated which is a risk are also generated. iRAP to preventing the more than 3 500 road deaths that registered charity dedicated to preventing occur every day worldwide - provides star the more than 3 500 road deaths that ratings for vehicle occupants occur every daypedestrians--for a length of motorcyclists worldwide - provides star ratings for vehicle occupants options to road--and identifies treatment improve these ratings. motorcyclists pedestrians--for a length of road--and safer roadtreatment options to improve these traffic signals and raised speed-reducing platforms) Providing identifies crossings for pedestrians (such as ratings. is a key opportunity for all countries especially on higher-volume vehicle routes where there is major Providing safer roadProvision of footpaths along many stretches of roads and streets is another treatment pedestrian activity. crossings for pedestrians (such as traffic signals and raised speed-reducing platforms) isthat would improvefor all countries especially on higher-volume vehicle routes where there is major a key opportunity safety outcomes. pedestrian activity. Provision of footpaths along many stretches of roads and streets is another treatment Lowering speed limits in outcomes. that would improve safety higher pedestrian traffic areas--30 km h is always recommended--plus supportive infrastructure treatments (such as footpaths and median refuges for road crossings) will reduce pedestrian serious speed limits many LMICs pedestrians areas--30 km h is always six or more lanes of traffic Loweringcasualties. In in higher pedestrian trafficare often expected to cross recommended--plus supportive without signals or speed tables and with poor vehicle operator compliance with pedestrian crossing rules infrastructure treatments (such as footpaths and median refuges for road crossings) will reduce pedestrian (usually painted on the road surface with no signage). serious casualties. In many LMICs pedestrians are often expected to cross six or more lanes of traffic without signals or speedindicateand with poor vehicle speed limit should apply for motorcycles--and for Safe system principles tables that a 40 km h travel operator compliance with pedestrian crossing rules (usually paintedsharing road surface with no signage). other vehicles on the the road (if a separate motorcycle right of way is not provided) in areas of higher motorcycle activity. This is challenging for any government and to date there has been little preparedness to Safe systemissue. However safethat a 40principles indicate the need for measuresmotorcycles--and for tackle this principles indicate system km h travel speed limit should apply for of this type to be considered. other vehicles sharing the road (if a separate motorcycle right of way is not provided) in areas of higher Safer Vehicles (Longer Term) motorcycle activity. This is challenging for any government and to date there has been little preparedness to tackle this issue. However safe adoption of the Euro NCAPthe need for measures Programme) standard for Opportunities here include the system principles indicate (New Car Assessment of this type to be considered. safety features for new vehicles imported into a country or produced in the country promotion of pedestrian further innovative technologies (e.g. bonnet airbags and crash-avoidance systems) that offer the prospect of Safer Vehicles for VRUs especially pedestrians and while still a somewhat aspirational objective for most improved safety (Longer Term) LMICs encouraging the fitting and use of integrated alcolocks in new vehicles to prevent driving while alcohol Opportunities here include the adoption of the Euro NCAP standard forwhich is independent of industry and impaired. Euro NCAP is an international association under Belgian law pedestrian safety features for new political control. makes available to consumers independent information about a car s comparative safety. vehicles importedItinto a country or produced in the country promotion of further innovative technologies (e.g. bonnet airbags and crash-avoidance systems) that offer the prospect of improved safety for VRUs In this regard the activities of the World Forum for Harmonization of Vehicle Regulations (WP .29) are also especially pedestrians and while still a somewhat aspirational objective for most LMICs encouraging the noteworthy. WP is a UNECE body that in the framework of United Nations legal instruments develops .29 fitting and use of integrated alcolocks in new vehicles to prevent driving while alcohol impaired. Euro NCAP harmonized vehicle regulations that can be applied worldwide. These regulations promote the design and isconstruction of safer and more environmentally-friendlyis independent of industry and political control.have an international association under Belgian law which vehicles. To date over 140 vehicle regulations It makes developed inconsumers independent information about aenergy. The regulations are based on detailed been available to areas such as passive safety pollution and car s comparative safety. research and subsequent adoption by WP members. They are all annexed to and form an integral part of .29 In this regard the activities ofRegulations Agreements. .29) are also the 1958 and 1998 Vehicle the World Forum for Harmonization of Vehicle Regulations (WP w www.icap.org e info icap.org 0 noteworthy. WP is a UNECE body that in the framework of United Nations legal instruments .29 develops harmonized vehicle regulations that can be applied worldwide. These regulations promote the design and construction of safer and more environmentally-friendly vehicles. To date over 140 vehicle regulations have been developed in areas such as passive safety pollution and energy. The regulations are based on detailed research and subsequent adoption by WP members. They are all annexed to .29 and form an integral part of the 1958 and 1998 Vehicle Regulations Agreements. Further opportunities are under examination. Safer Road User Behavior Legislation Enforcement and Public Education Safer Road User Behavior Legislation Enforcement and Public Education Targeted efforts to change behaviors (through a combination of legislation enforcement and public education) could include improving compliance by drivers and riders with speed limits (requiring clear and frequent signage) and deterring driving while impaired with alcohol (such as by setting a BAC limit of zero for novice drivers and drivers of heavy vehicles or public transport and a limit of 20 50 mg 100 ml for all other drivers). While currently likely to be controversial deterrence of walking on roads--by creating and enforcing an offense for road use as a pedestrian when having a BAC greater than 150 mg 100 ml--merits serious consideration to address the crash risk of alcohol-impaired pedestrians. This type of measure could also be extended to cyclists. A zero BAC limit could be considered for motorcyclists given the high degree of handling expertise required and the higher risk of a crash associated with motorcycling. Other action jurisdictions could take to target unsafe behaviors should include efforts to deter driving while impaired with drugs walking when impaired by drugs and non-wearing of helmets by motorcycle riders and passengers. It is essential for police to enforce vehicle speed limits at all times BAC limits for drivers riders and if legislated BAC limits for pedestrians and cyclists especially at times and locations where drinking is more likely to occur. Public campaign strategies should be developed and implemented to raise awareness of alcohol-impaired driving riding or walking and to promote how enforcement will contribute to changed behaviors (and attitudes in the longer term) and serve to ultimately make these behaviors socially unacceptable. An example of awareness raising i.e. encouraging local governments to stencil this logo on footpaths outside pubs and clubs in their regions. (Pedestrian Council of Australia NSW Australia) 16 An example of awareness raising i.e. encouraging local governments to stencil this logo on footpaths outside pubs and clubs in their regions. (Pedestrian Council of Australia NSW Australia) Partnership between government agencies and the alcohol industry is recommended to introduce and promote responsible serving and the alcohol industry is recommended to Partnership between government agencies of alcohol (see below) and associated regulations for promote responsible servingpublicity campaigns for and associated introduce and licensed premises. Focused of alcohol (see below) patrons of licensed premises are also strongly recommended. regulations for licensed premises. Focused publicity campaigns for patrons of licensed premises are also strongly recommended. Post-crash Emergency Care Post-crash Emergency Care It is necessary for the emergency medical system to work consistently to improve the timeliness of the retrieval of crash victims from the roadside and their prompt conveyance to hospital trauma care facilities. The development of competent paramedic care and its availability at the roadside for crash victims the providing of high-quality trauma care and the provision of improved rehabilitation care are all factors that will reduce fatalities and many of the most serious effects of some long-term injuries. Any of the above (or other) actions that are proposed to reduce alcohol-involved VRU fatalities or serious injuries needs to be based on an understanding of the factors involved in those crash categories. This should be based on evidence and experience from other countries an analysis of national data on VRU fatalities and serious injuries (overall and alcohol impaired) and comparisons with data from other countries. Effective action will also require recognition of the particular challenges in this area that are present in your country and identification of what you can adapt and apply from the experience of others. Potential Interventions to Reduce Potential Interventions to Reduce Alcohol-Impaired Pedestrian Fatalities Alcohol-Impaired Pedestrian Fatalities With an understanding of factors in crashes involving alcohol impaired pedestrians what are some of the interventions that could be introduced The list is extensive and includes the following lower speed limits improved street lighting and low-height pedestrian fencing at curbs outside licensed premises and in bar precincts all-red phases for traffic lights after hours at intersections in bar precincts median refuges and crosswalks with signals or speed platforms tables for pedestrians especially in urban areas. Public information campaigns could be developed and delivered extensively to provide information about the nature and extent of the intoxicated-pedestrian problem Innovative mass media campaigns can play an important part in changing behaviours. For example the Pedestrian Council of Australia featured this poster in a public campaign about pedestrian crash risk and pedestrian distraction. While not specific to alcohol impairment it reminds us of the impact of effective images and messages. w www.icap.org e info icap.org 0 and seek to lessen binge drinking and excessive consumption. Programs of this type serve in the longer term to support establishment of a new social norm that is not supportive of excessive alcohol consumption. Policies promoting the responsible serving of alcohol at licensed premises could be developed and adopted in association with the alcohol industry and should include the following Adoption house policies and staff training to ensure staff know Adoption of of house policies and staff training to ensure staff know how to refuse alcohol service to service to intoxicated patrons. how to refuse alcoholintoxicated pedestrians. Provision of free or inexpensive food when patrons call for drinks after work. Provision of free or inexpensive food when patrons call for drinks after work. Abandoning happy hour policies for Abandoning happy hour policies for cut-price drinks. cut-price drinks. Providing free nonalcoholic drinks for designated drivers and displaying Promoting low-alcohol or alcohol-free drinks. warning messages on premises about risks of pedestrian impairment. Providing free nonalcoholic drinks for designated drivers and displaying warning messages on for patrons. Arranging transport home premises about risks of pedestrian impairment. Arranging transport home for patrons. Further countermeasures as explored by Mr Blomberg and Mr Fell (1979) include consideration of Further countermeasures as explored by Blomberg suggested earlier in this paper) the regulations prohibiting walking whilst intoxicated (asand Fell (1979) include consideration of regulations prohibiting of at-risk groups in order (as suggested earlier in this paper) the development of profiles walking whilst intoxicated to guide appropriate action by enforcement development of profiles of at-risk groups in order to guide appropriate action such as use of agencies lowering of alcohol content especially of beer engineering treatments by enforcement agencies lowering of alcohol content especially of beer engineering quick transportation to barriers or curbs tilted away from the street good pre-hospital care and treatments such as use of barriers and well-trained healthcare providers and pre-hospital care and hospital or curbs tilted away from the street good trauma-care systems. quick transportation to hospital and well-trained healthcare providers and trauma-care systems. Case Study Infrastructure Treatments to Reduce Case Study Infrastructure Treatments to Reduce Pedestrian Fatalities Including Alcohol-Involved Pedestrian Fatalities Including Alcohol-Involved Pedestrian Fatalities Pedestrian Fatalities Attention is drawn to two studies (from Australia and the United that used of Great Britain and Attention is drawn to two studies (from Australia and the U.K.) Kingdom infrastructure Northen Ireland) that used infrastructurephasing late at night at times of higher phasing late at night treatments-- rest on red traffic signal treatments-- rest on red traffic signal alcohol-impaired at times of higher alcohol-impaired pedestrian crash risk and adjacentcrash risk. premises--to pedestrian crash risk and adjacent to licensed premises--to reduce to licensed reduce crash risk. The results of the trial conducted in Australia (Corben et al. 1996) included a reduction in mean The results of the trial km h (28%)in Australia (Corben et al. during included a reduction evening that vehicle speeds of 11 conducted at the signals stop lines 1996) the periods of each in mean vehicle speeds of 11 km h (28was also aat the signals stop lines 52% in the periods of each evening the treatment applied. There per cent) measured reduction of during vehicles traveling at that the treatment applied. km h). was also a measured reduction of 52 per cent in vehicles traveling threatening speeds ( 30 There at threatening speeds ( 30 km h). 18 In the U.K. this infrastructure treatment (in combination with puffin crossings) resulted In the U.K. this infrastructure treatment (in combination with puffin crossings) resulted in in 76% fewer fewer fatal and injury crashes and 75 per cent fewer fatal and injury crashes 76 per cent fatal and injury crashes and 75% fewer fatal and injury crashes involving pedestrians (unpublished evaluation report of U.K. of U.K. study B. Turner personal involving pedestrians (unpublished evaluation reportstudy B. Turner personal communication April 2013). communication April 2013). Possible infrastructure treatments to reduce pedestrian serious-casualty crash risk (left to right) pedestrian fencing outside licensed premises and adjacent to pedestrian crossings painted medians (providing some refuge for pedestrians) in busy pedestrian areas painted crosswalks to more clearly identify pedestrian priority areas (Corben & Duarte 2000). Approach if Alcohol Consumption in aaCountry Is Approach if Alcohol Consumption in Country Is Currently Low Currently Low Where a culture of alcohol consumption is not in place (e.g. as in most Muslim countries) there is an opportunity to prevent the increase in road safety risks associated with more widespread alcohol impairment. It is useful to note however that alcohol impairment will probably exist to some extent in any society and therefore measures to contain and if possible reduce the likelihood of an increase in impairment incidence should be devised and implemented. In these lower-consumption countries and indeed for all other societies consideration should be given not only to what can be done to reduce pedestrian cyclist and motorcyclist deaths involving alcohol but what can be done to create a safe system--at least for pedestrians and cyclists--in the early stages. Actions devised should rely on evidence and focus on tackling drink driving drink riding (and travel speed reductions in urban areas) as highly effective ways to reduce pedestrian and cyclist deaths related to alcohol consumption rather than targeting intoxicated pedestrians. Assessments of crash risks can be carried out. For example a new app for iOS devices provides a ready means of assessing and rating pedestrian crossing locations for safety on a scale of 1 to 5. Called Walk this Way it has been developed by the Monash University Accident Research Centre. The app acknowledges the significance of vehicle travel speeds as the key determinant of pedestrian safety when crossing roads (see Corben 2013). The planned interventions should then be delivered--meeting the challenges that the move from concept to delivery always entails. w www.icap.org e info icap.org 0 Conclusions Conclusions There are many challenges associated with reducing the serious crash involvement of VRUs that relate to alcohol impairment of road users. The overall nature of alcohol consumption with the diversity of cultural issues and settings in each country requires locally appropriate responses to be devised and implemented. The problems need to be measured as precisely as is feasible and any other available data must be used to guide intervention selection. Many road traffic injuries are largely preventable. The evidence base for effective interventions to better protect VRUs from serious casualties involving alcohol impairment is extensive. Observations from the Regions The following papers provided by experts refer to the road safety challenges associated with alcohol impairment in their own countries and regions. This is an important opportunity to share information and understanding about existing conditions in these countries and to consider how good practice (as alluded to in this introductory paper and in those regions) might be disseminated or shared more widely. How can further capacity--for research analysis development--as part of overall road safety performance improvement be fostered and developed in LMICs How can the necessary resources be found and applied Matching solutions to problems in this area and being as innovative as the cultural environment permits requires knowledge skill courage and support from local and international colleagues the alcohol industry and international injury-prevention organizations. This publication is an effort to support the necessary momentum for change. References Blomberg R. & Fell J. (1979). A comparison of alcohol involvement in pedestrians and pedestrian casualties. In Proceedings of the American Association for Automotive Medicine (pp. 1-17) October 3-6 Louisville KY. Cairney P Stephenson W. Macaulay J. & Austroads. (2004). Preventing crashes involving intoxicated pedestrians. Sydney . Austroads. Corben B. (2013 May 8). Opportunities to create low risk environments for pedestrians [Seminar presentation]. Retrieved June 13 2013 from http www.carrsq.qut.edu.au community low_risk_environments_for_peds.pdf. Corben B. Diamontopoulou K. Mullan N. & Mainka B. (1996). Environmental countermeasures for alcohol-related pedestrian crashes (Report No. 101). Melbourne Monash University Accident Research Centre. Corben B. F. & Duarte A. (2000). Injury reduction measures in areas hazardous to pedestrians. Stage 1 Countermeasure options (Report No. 169). Melbourne Monash University Accident Research Centre. Foss R. D. Harkey D. L. Reinfurt D. W. & Marchetti L. M. (1997). High alcohol-involved pedestrian crash sites Driver and pedestrian behaviour. In C. Mercier-Guyon (Ed.) Proceedings of the 14th International Conference on Alcohol Drugs and Traffic Safety (pp. 1-167). Annecy France CERMT. Struik M. & Rogerson P (1988). Pedestrian accident project report no. 5 Methodology and general results (Report No. . GR 88 7). Hawthorn Victoria Road Traffic Authority. World Health Organization (WHO). (2013). Global status report on road safety 2013. Geneva Author. 20 Biography M r. E r i c H o w a r d Mr Eric Howard Pr i n ci p a l Principal W h i t i n g M o y n e C o n s u l t i n g P t y LLtd Whiting Moyne Consulting Pty t d Mo de ra to r E ri c Ho wa rd is the Pr inci pa l of W hiti ng Mo yne a Str a teg ic RModerat or yMrdEric r y C o n s uist a n c yPrincipal g i n t e r n a t i oMoyne r i c i s o a d S a f e t A v i s o Howard l the o p e r a t i n of Whiting n a l l y. E a Strategic e n e r a lSafety g e r R o a d S a f e t y w i t h V ioperatingt h e S t a t e R o a d f o r m e r l y G Road M a n a Advisory Consultancy c R o a d s internationally. Eric is formerly General Manager Road Safet y with S af e ty A ge n c y Roa d A u th or it y i n Vic t or ia A u s tr al ia . He is a n VicRoads the State Road Safet y Agency Road Authority in i n t e r n a t i o n a l l y ralia. g n i s isdanx p e r t o n t h e s t r e n g t h e n i n g o f r o a d on f e t y Victoria Aust r e c o He e e internationally recognized expert s a m a n a g e m e n t c a p a cofyroad isafetyemanagementt h e d e v e l o withint o f the strengthening i t w i t h n g o v r n m e n t a n d capacity p m e n pgovernment eand e r o a d s a f e t y p o l i c i epractical a effectsive v o l v i n g r a c t i c a l e f f c t i v the development of s a n d s t r t e g i e i n road safety tpolicies oandr s . r e l e v a n s t a k e h l d e strategies involving relevant stakeholders. Click to Eric Howard p United Nations G Click to download the full presentation Click to download the full EricEric Howard provided for the 2013 Mr Howard presentation for the 2013 United Nations Global Road Safety Week United Nations Global Road safety Week Eric Howard signing the We DRIVE BY THE RULES pledge w www.icap.org e info icap.org 0 Alcohol-Related Road Crashes Alcohol-Related Road Crashes Involving Vulnerable Road Users involving Vulnerable Road Users in Malaysia Issues and Challenges Issues and Challenges Mr Shaw Voon Wong Professor Dr. Shaw Voon Wong Director-General Malaysian Institute of Road Safety Research Lot 125-135 Jalan TKS 1 Taman Kajang Sentral 43000 Kajang Selangor Malaysia Email wongsv miros.gov.my Driving under the influence of alcohol is one of the main and Driving under the influence of alcohol is one of the main and well-recognized risk factors for road traffic collisions. Many well-recognized risk factors for road traffic collisions. Many countries have set up a blood alcohol content (BAC) legal countries have set up a blood alcohol content (BAC) legal limit to prevent drinking and driving. However the BAC limit limit to prevent drinking and driving. However the BAC limit varies by country. Developed countries have recognized the varies by country. Developed countries have recognized the need to lower the BAC limit and have even considered need to it down to zero although many others still remain at bringing lower the BAC limit and have even considered bringing it 0.08 to cent although many others still remain at the level of downperzero (0.08 g dl). the very conservative level of 0.08% (0.08 g dl). Recently further attention has been given not only to drinking Recently further attention has been given not only to drinking and driving but also drinking and walking. The success of and driving but driving in developed countries has prioritizing drinkalso drinking and walking. The success of prioritizing drink driving in developed countries has successfully brought down the number of road traffic successfully brought down the number of road traffic collisions and thus led to recognition of the need to keep Norlen Mohamed Dr. Norlen Mohamed drinking and walking in to recognitionhas also carried the collisions and thus led control. This of the need to keep Director Vehicle Safety and Biomechanics Research Centre interest of looking into the influence has also carried the drinking and walking in control. This of alcohol consumption of Malaysian Institute of Road Safety Research vulnerable looking into the influence of alcohol consumption of interest of road users including bicyclists and motorcyclists on road traffic collisions. No doubt drink driving is a very vulnerable road users including bicyclists and motorcyclists prominent risk collisions. road trafficdrink drivingbuta very on road traffic factor for No doubt collisions is drinking and riding has a much higher crash risk especially at lower BAC prominent risk factor for road traffic collisions but drinking and levels (0.02 per cent 0.09 per cent) due to impairment in riding has a much higher crash risk especially at lower BAC Malaysia concentration reasoning peripheral vision and glare recovery. levels (0.02% 0.09%) due to impairment in concentration Drinking and cycling or biking has a higher risk of severe injury reasoning peripheral vision and glare recovery. Drinking and than drink driving even at low impact speed because riders are cycling or biking has a higher risk of severe injury than drink driving even at low impact not protected by the vehicle structure. Furthermore the risk exposure of drinking and riding speed because severe injury could also be higher than drinking and walking in view as well as the risk of riders are not protected by the vehicle structure. Furthermore the risk of exposure of drinking and riding as well as the risk walking. the fact that riding involves much higher speeds than of severe injury could also be higher than drinking and walking in view of the fact that riding involves much higher speeds than walking. 22 important to recognize such risks It is very important to recognize such risks in developing countries that have especially in developing countries that have the road. a high number of motorcycles on the road. Asian In the Association of Southeast Asian Nations (ASEAN) region motorcycles are motorcycles are one of the major modes of transportation. transportation. For instance Malaysia has 9 985 308 9 985 308 registered motorcycles which constituted about 47 per cent of all 47% of all which constituted aboutmotorized vehicles on the road in 2011. Other ASEAN countries motorized vehicles on the road in 2011. have ASEAN countries have a similarly Othera similarly high composition of motorcycles on their road as of motorcycles on high compositionshown in Table 1. their road as shown in Table 1. Table 1. Registered Vehicles ASEAN Countries Table 1. Registered Vehicles inin ASEAN Countries Country Year of Data Brunei Darussalam 2010 Brunei 2010 Total Registered Vehicles 349 279 349 279 1 652 534 1 652 534 114 592 000 114 592 000 72 692 951 72 692 951 21 401 269 21 401 269 2 326 639 2 326 639 6 634 855 6 634 855 945 829 945 829 28 484 829 28 484 829 33 166 411 33 166 411 Registered Motorized 2- and 3-Wheelers n a n a 1 372 525 1 372 525 82 402 000 82 402 000 60 152 752 60 152 752 9 985 308 9 985 308 1 911 040 1 911 040 3 482 149 3 482 149 n a n a 17 322 538 17 322 538 31 452 503 31 452 503 Motorized 2- and 3Wheelers as a Proportion of All Vehicles (%) n an a 83 83 72 72 83 83 4747 82 82 52 52 n an a 61 61 95 95 Cambodia 2010 Cambodia 2010 India 2009 India 2009 Indonesia 2010 Indonesia 2010 Malaysia 2011 Malaysia 2011 Myanmar 2011 Myanmar 2011 Philippines 2010 The Philippines 2010 Singapore 2010 Singapore 2010 Thailand 2010 Thailand 2010 Vietnam 2010 Viet Nam 2010 Source World Health Organization (WHO). (2013). Global status report on road safety 2013. Geneva Author It is crucial for an intervention to be based on reliable data and sound analysis. The fundamental issue is whether a country especially one that is developing or underdeveloped has enough data to support the implementation of a policy and program for vulnerable road users. Does it have a comprehensive data-collection system for alcohol-related fatalities injuries and crashes Most countries rely on police-based data which are often biased by underreporting for many reasons including lack of capability and resources. Police data are linked directly to prosecution and carry legislative implications and thus may be subject to integrity w www.icap.org e info icap.org 0 issues as well as humanitarian considerations such as sympathy for the victim. issues as well as humanitarian considerations such as sympathy for alcohol-related The latter reason has a significant influence in the underreporting of the victim. The latter This is particularly true ininfluence inclaiming and prosecution which would crashes. reason has a significant insurance the underreporting of alcohol-related crashes. This is particularly settlein insurance claiming and prosecution which would need considerable time to true as compared to a typical road traffic collision. need considerable time to settle as compared to a typical road traffic collision. Hence the data may not be sound enough to accurately represent the seriousness of Hence the data may not be sound enough to accurately represent the seriousness of alcohol-related crashes or support allocation and effort to prevent alcohol-related alcohol-related crashes or support allocation and effort to prevent alcohol-related crashes which may compromise overall efforts to reduce road traffic fatalities. crashes which may compromise overall efforts to reduce road traffic fatalities. According to the Royal Police of Malaysia alcohol impairment was involved in an According to the Royal Police of Malaysia alcohol impairment was involved in an average of 0.7% of drivers and riders in fatal crashes between 2001 and 2011. Would average of 0.7 per cent of drivers and riders in fatal crashes between 2001 and 2011. this reflect the reality on the ground Based on this figure no decision makers would Would this reflect the reality on the ground Based on this figure no decision makers spend scarce resources to prevent alcohol-related crashes. In many countries it is a would spend scarce resources to prevent alcohol-related crashes. In many countries common practice by enforcement authorities to administer BAC BAC only only to it is a common practice by enforcement authorities to administer tests teststo drivers and riders riders involved in crashes who are suspected of impairment. The drivers andinvolved in crashes who are suspected of alcoholalcohol impairment. The investigation officer in charge of the particular case has to exercise his or her investigation officer in charge of the particular case has to exercise his or her discretion. Of 9 052 drivers and riders involved in fatal accidents in 2011 only 101 discretion. Of 9 052 drivers and riders involved in fatal accidents in 2011 only 101 (1.1 perwere suspected of alcohol impairment and sent for testingtesting (Table 2). (1.1%) cent) were suspected of alcohol impairment and sent for (Table 2). Table Police Statistics on Alcohol Impairment among Drivers and Riders Table 2.2. PoliceStatistics on Alcohol Impairment among Drivers and Riders Involved in Road Crashes in Malaysia Involved in Road Crashes in Malaysia Crashes involving 1 fatality Alcohol impairment Not suspected Tested positive Tested negative Total 349 279 1 652 534 114 592 000 72 692 951 9 052 Crashes involving 1 serious injury n a 1 372 525 82 402 000 60 152 752 7 559 Crashes involving 1 minor injury n a 83 72 83 14 853 31 464 Source Polis DiRaja Malaysia 2011. The Malaysian Institute of Road Safety Research conducted a study involving all The Malaysian Institute of Road Safety Research conducted a study involving all fatally injured drivers riders and pedestrians admitted to the forensic medicine fatally injured drivers riders and pedestrians admitted to the forensic medicine department of Hospital Kuala Lumpur from 2006 to 2009. Hospital Kuala Lumpur is department of Hospital Kuala Lumpur from 2006 to 2009. Hospital Kuala Lumpur is the general hospital one of the most established hospitals in Malaysia serving the the general hospital one of the most established hospitals in Malaysia serving the country s capital and its surrounding area. The study revealed alarming results country s capital and its surrounding area. The study revealed alarming results about 28.1% of fatally injured drivers tested positive for alcohol as well well as about 28.1 per cent of fatally injured drivers tested positive for alcohol asas 22.1% of riders and 20.0% of pedestrians. 22.1 per cent of riders and 20.0 per cent of pedestrians. 24 The hospital-based study confirmed that alcohol-related crashes are significantly underreported by the police. This is not an isolated challenge as many other countries face a similar problem. Furthermore the WHO Global Status Report on Road Safety 2013 revealed that almost half of all countries lack data on alcohol-related crashes. The underreporting or lack of data is the biggest challenge for any country to overcome in justifying the resources for any prevention initiative as well as monitoring trends in alcohol-related crashes. Hospital-based data seem to be a promising alternative to police-based data. It is well recognized that most countries have BAC limits for driving but these range from zero tolerance to 0.08 per cent. With such differences it would be very difficult for any policy-maker especially in developing countries to support a review of the present BAC limit in their respective country. The review becomes more complicated when there is disagreement about the appropriate limits for different road users since certain communities have very different views on alcohol in society. Furthermore there is little effort to establish the BAC limit for pedestrians riders and passengers. It is well recognized in the UN Decade of Action that addressing alcohol-related crashes is crucial. Finding a universal approach in handling drinking and driving drinking and walking and drinking and riding may not be realistic. This is especially true for a multicultural country such as Malaysia where the Muslim majority refrain from consuming alcohol while the other 40 per cent of the population have different religions and cultures and may view alcohol consumption as socially appropriate in certain contexts. w www.icap.org e info icap.org 0 Recommendation Recommendation white that will the UN that will recognize the need for Member States We recommend preparing a paper paper torecognize the need for UN Member States to We recommend to develop more comprehensive and effective data-collection mechanism for alcohol-related develop a a more comprehensive and effective data-collection mechanism for alcohol-related practical and common method to achieve such mechanism. is crashes and to produce a practical and common method to achieve such aamechanism. It It is crashes important to recognize the need to reduce alcohol impairment not only among drivers but among to reduce alcohol impairment not only among drivers but among important pedestrians cyclists and riders and their passengers. It is suggested that the paper encourages and their passengers. It is suggested that the white paper pedestrians propose for the UN to urgently adopt the WHO recommendation to urgently adopt the WHO UN Member States strongly encourage all its Member States that BAC limits be set at recommendationgeneral drivers and set atper centfor 0.05 per cent for that BAC limits be 0.02 0.05% for general drivers andis an immediate need to come is riders. Lastly there 0.02% for riders. Lastly there out an immediate need to review outaddress the gap so with a comprehensive come to with a comprehensivefor specific vulnerable road users can that BAC limits review to address the gap so that BAC be proposed to address drinking and walking then limits for specific vulnerable road users can then be proposed in the drinking and to address drinking and riding and white paper cycling. drinking and walking drinking and riding and drinking and cycling. BAC limits be set at 0.05 per cent for BAC limits be set at 0.05% for Drivers and Drivers and 0.02 per cent for Riders. 0.02% for Riders. 26 Biography Mr Shaw Voon n g P r o f . S h a w V o o n W oWong A sAsia e Presenter ia Pr sente r P r o f e s s o r D r. W o n g S h a w V o o n i s D i r e c t o r- G e n e r a l o f t h e M a l a y s i a n Mr Shaw Voon S a f e t R Director-General t i n a Malaysian I n s t i t u t e o f R o a d Wongyis e s e a r c h . H e i s n aofothel l y a n d i n t e r n a t i o n a l l y Instit ute of Road Safet y Research. He is nationally and k n o w n f o r h i s e x p e r t i s e i n r o a d s a f e t y. internat ionally know n for his ex pertise in road safety. P r o f e s s o r Whas helped lestablish b l i s h n u m e r o u s n a t i o n a l a n d Mr Wong o n g h a s h e p e d e s t a numerous national and i n tinternatn a l r o a d s asafetiy iinittiativesnand tinterventions c l u d i n g r e a r e r n a t i o ional road f e t y n t i a i v e s a d i n e r v e n t i o n s i n including s erear lseatbeltalaw a l i m p l e mimplementationwframework W PUN WP29 a t b e t l a w n t i o n national e n t a t i o n f r a m e o r k o f U N of 2 9 R eRegulations -in-depthr a s h a nandcaccidentadatabase nandt h e r s . g u l a t i o n s i n d e p t h c crash d a c i d e n t d t a b a s e a d o others. He publishes extensively on road safety in scientific journals. He pu b li s h es e xten s i ve ly o n r oa d s a f et y in s c ie n tif i c j ou r n a ls . Click to to view the video presentation Click view the video presentation MrProfessor Wong Shaw Voon provided 2013 Shaw Voon Wong provided for the for the 2013 United Nations Global Road safety Week United Nations Global Road Safety Week w www.icap.org e info icap.org 0 RegionalPerspectives onon Preventing Regional Perspectives Preventing Alcohol-Related Road Crashes Involving Alcohol-Related Road Crashes Involving Vulnerable Road Users Sub-Saharan Vulnerable Road Users Africa Africa Introduction Introduction The paper will discuss drink driving issues in the SubThe paper will discuss drink driving issues in the Sub-Saharan 1 Saharan countries on continent. continent. Sub-Saharan countries on the Africanthe African Sub-Saharan Africa bears Africa bears the greatest burden of road with crashes the greatest burden of road traffic crashes trafficover 235 000 with over 235 000 people killed annually This constitutes people killed annually (WHO AFRO 2009).(WHO AFRO 2009). This constitutes almost 20% of all road yet the almost 20 per cent of all road deaths worldwide deaths region worldwide yet the region has only 2% of the world s has only 2 per cent of the world s registered vehicles while Mr Wilson Odero Dr Wilson Odero Europe withvehicles while Europe with 26% of all motor only registered 26 per cent of all motor vehicles contributes School of Medicine Maseno University Kenya Email wodero gmail.com 8 vehicles of the globalonly 8% of the (Pedenroad fatalities per cent contributes road fatalities global et al. 2004). For everyet al. 2004). For many death there are many more (Peden death there are every more injured and disabled resulting and disabled medical social and national injured in substantial resulting in substantial medical developmental costs developmental costs with an social and national with an estimated economic cost ranging between 1 per cent and 5 per cent of a country s gross national estimated economic cost ranging between 1% and 5% of Africa Kenya product (Jacobs Thomas & Astrop 2000). Sub-Saharan Africa a country s gross national product (Jacobs Thomas & has the highest road traffic fatality rates in the world at 32.3 Astrop 2000). Sub-Saharan Africa has the highest road deaths per 100 000 population far in excess of the average global rate of 18.8 per 100 000 traffic fatality rates in the world at 32.3 deaths per 100 000 population far much in excess of the (WHO AFRO 2009). However the range of fatality rates varies considerably between the countries average global rate of 18.8 per 100 000 (WHO AFRO 2009). However the range of fatality rates with Nigeria and South Africa having the highest at 33.7 and 31.9 per 100 000 population varies considerably between the countries with Nigeria and South Africa having the highest at respectively. Seven countries--Democratic Republic of the Congo Ethiopia Kenya Nigeria South 33.7 and 31.9 perand Uganda--contribute 64 per cent of all countries--Democratic in the region Africa Tanzania 100 000 population respectively. Seven road deaths that occur Republic of the Congo Ethiopia Kenya Nigeria South Africa Tanzania and Uganda--contribute 64% of all (WHO AFRO 2013). road deaths that occur in the region (WHO AFRO 2013). Whereas road traffic injuries affect all age groups the greatest burden is borne by young adults Whereas road traffic injuries affect all account for 62 per cent of burden is bornein Sub-Saharan aged between 15 and 44 years who age groups the greatest all road deaths by young adults aged between 15 and 44 years who vulnerable (WHO of all road deaths in Sub-Saharan Africa Africa and young men are the most account for 62% AFRO 2013). As highlighted in the Global and young men are the Safetyvulnerable (WHO AFRO 2013). As highlighted in the Global Status Status Report on Road most (WHO 2013a) vulnerable road users (VRUs) who include pedestrians Report on Road Safety three-wheeled vehicles areroad greater risk of road include pedestrians and users of two- and (WHO 2013a) vulnerable at a users (VRUs) who crashes than vehicle and users ofThe majority of road users involvedareroad greater risk of road crashes than vehicle occupants. two- and three-wheeled vehicles in at a crashes in Sub-Saharan Africa are VRUs representing 52 per cent of road users killed with pedestrians accounting for 38 per cent of all road occupants. The majority of road users involved in road crashes in Sub-Saharan Africa are VRUs traffic deaths (WHO 2013a). The increased risk of road crashes by for38% largely attributed representing 52% of road users killed with pedestrians accounting VRUs is of all road traffic to the variety (WHO 2013a).The increasedthe roads inability to incorporate largely attributed to the deaths and intensity of traffic mix on risk of road crashes by VRUs is the needs and safety of VRUs and intensity of traffic mix on the roads inability to incorporate the needs crossings of variety in transport planning and road designs low or lack of driver compliance at and safety and intersections alcohol consumption designs low or lack of driver compliance at crossings and VRUs in transport planning and roadand inappropriate behavior of pedestrians such as non-use of pedestrian crossings and not obeying traffic lights (WHO 2013a b). Vulnerable road users intersections alcohol consumption and inappropriate behavior of pedestrians such as non-use of pedestrian crossings and not obeying traffic lights (WHO 2013a b). Vulnerable road users 1 In this paper Sub-Saharan Africa is comprised of all countries on the African continent with the exception of Morocco Libya Tunisia Egypt Sudan and Somalia. In this paper Sub-Saharan Africa includes Algeria. 28 therefore remain the weakest party in a road traffic crash and pose the greatest challenge to today s road safety efforts in Sub-Saharan Africa. This paper highlights the social and cultural dimensions of alcohol consumption the extent of alcohol consumption among vulnerable road users key challenges in preventing alcohol-related crashes and suggests some strategies for reducing hazardous alcohol use among vulnerable road users. Culture of Alcohol Consumption Historically traditional African brews made from a variety of plants mainly sorghum maize Historically traditional African brews made from a variety of plants mainly sorghum maize wheat millet cassava banana and palm fruits played an important role inin various social and millet cassava banana and palm fruits played an important role various social and cultural activities and were not meant for trade (Acuda 1985). The coming of European rule cultural activities and were not meant for trade (Acuda 1985). The coming of European rule in Africa saw many fermented drinks outlawed while at the same time imported distilled liquor Africa saw many fermented drinks outlawed while at the same time imported distilled liquor was introduced for the first time as commodities of trade resulting in the use of these exotic introduced for the first time commodities of trade resulting in the use of these exotic drinks gradually becoming more common (Pan 1975 as cited in Acuda 1985). Subsequently a gradual shift from the traditional brews to European drinks occurred supported by extensive advertising resulting in alcohol being produced largely for commercial rather than for social purposes. Despite this commercialization numerous types of homemade drinks some illicit are being produced and made readily available at low cost in many African countries. A variety of alcohol beverages some known by various local names exist in different countries. In Nigeria for instance the common alcohol beverages are palm wine (burukutu) beer and spirits (Ebie 1990). Likewise in Cameroon millet-based traditional brews palm wine beer and spirits are widely consumed (Yguel et al. 1990). In Tanzania homemade beer (pombe) palm wine (tembo) and illicit distilled spirits (gongo) continue to dominate the market and local drinking places (Maula 1990). In Uganda waragi a distilled beverage made from cassava bananas millet or sugarcane is the most popular and widely drunk liquor which contributes to the high rate of alcohol consumption per capita in the country (WHO 2011). A similar situation is found in Kenya where fermented local brews from cereals (busaa) or sugarcane and fruit (muratina) and locally distilled illicit spirits (chang aa) are commonly consumed in rural areas and peri-urban slums (Silberschmidt 1990). Chang aa with a high concentration of pure alcohol is easily available and inexpensive. w www.icap.org e info icap.org 0 Drinking Patterns n s Types p e s o A l c o h o l D r i n k i n Patterns and Types of Alcohol Consumed Drinking Patterns and Types ofyAlcoholf Consumed C o n s u m e d Drinking g P a t t e rand a n d Tof Alcohol Consumed Anthropological studies show enormous diversity in the patterns of drinking and in how drinking is related .4)2 0 ( 345% &3 3) 7 &. 2- 53 % 6&23 49 the patterns of drinking and This diversity can to everyday life studies show enormous diversity aspects of culture and social .% how drinking is Anthropologicalrituals special occasions and other in . 4)& 0 44&2.3 %2 . .( life.in . ) 7 %2 . .( 3 2& 4&% 4 &6&29% 9 &terms of rituals special occasions and 30& 43 5 452& .% 3 & being be described in 2 45 3 30& 3 .3 .% of drinking and frequency of intoxication or ) 3 related to everyday life two dimensions regularity 4)&2 other aspects of culture and social life. % 6&23 49 . & %&3 2 &% can 1990). 47 % -&.3 .3 2&(5 2 49the %2 . .( acceptance or tolerance of drinking & .( This diversity . 4&2-3 Regularity of drinking refers to extent of .% 2&15&. 9 .4 8 4 . 2 drunk (Partanen be described in terms of two dimensions regularity of drinking and frequency of %25. 24 .&. &(5 2 49 2& &23 4 4)& &04 . & 2 4 &2 . & %2 . .( intoxication In general drunk (Partanen %2 . .( an acceptable&84&.4 refers to the extent of acceptance brews Regularity of drinking customary pleasure during communal in a society. or being drinking traditional 1990). is . (&.&2 %2 . .( 42 % 4 . 2&73 3 . &04 & 534 - 29 0 & 352& customary . 3 &49 of drinking in a society. In general drinking traditional brews is an acceptable%52 .( --5. or tolerance celebrations. acceptable norms on drinking are 2& . 4 5. 6&23 54 00 9 . % &2&.4 and to pleasure during)& &04 & . 2-3 . The acceptable norms on drinking are not universal but & & 2 4 .3 Thecommunal celebrations. %2 . .( not universal but apply in different contexts .4&843 .% 4 specific groups such as by age to (&.%&2 2& ( . such as For age gender religion and status. For - apply in different contexts and gender religion and status. by 30& (2 503 35 ) 3 9 (& specific groups .% 34 453example surveys in Nigeria and Zambia 2 &8 -0 & 3526&93 . (&2 .% example drinking byNigeria and16 9& 23 3 . 4 &04 & it is more - 2& &04 & 2 -&. (&% show 4) 4 %2 . .( boys aged Zambia show that drinking by boys aged 16 years is men aged 40 3) 7 that surveys in 9 93 (&% years is not acceptable while 7) & 4 3acceptable for not acceptable while and above (Room et &4 9& 23it is more acceptable for men aged 40 years and above (Room et al. 2002). years .% 6& - al. 2002). With regard to gender in nearly all countries a higher proportion of women than men do not drink 4) 2&( 2% 4 (&.%&2 nearly 02 0 24 . than men do not drink With regard to gender in . .& 2 9 5.42 &3 ) ()&2per cent of the 7 -&. 4) . -&. % . 4 %2 . ) alcohol. A survey in 20 African all countries a higher proportion of womenAfrican women are lifetime countries shows that 81 3526&9 . 2 .African countries shows that0&2 &.4 African women are lifetime abstainers 5.42 &3 3) 73 4) 4 4)& 2 . 7 -&. 2& &4 -& 34 .&23 7 4) alcohol. A survey in 20 abstainers with abstinence rates ranging from 5681% of thein Mauritius to 99 per cent in Comoros per cent 34 .&. & 2 4&3 2 .( .( 2 - of drinking . also strongly influenced . religion. Many religions 0&2 &.4 is 52 4 53 4 0&2 &.4 by - 2 3 53&. &4 (Clausen et al. rates ranging from 56% in Mauritius to 99% in Comoros (Clausen et al. 2009). The extent with abstinence 2009). The extent )& &84&.4 %2 . .( 3 3 342 .( 9 . 5&. &% 9 2& ( . .9 2& ( .3 2&( 2% abstaining from regard drinking ofstrongly influenced by religion. Many religions regarda holy life. In Islam %2 . .( ) of drinking is also alcohol beverages as incompatible with leading drinking of alcohol beverages as &6&2 (&3 3 . -0 4 & 7 4) & % .(and as a result 3 - 34 . .( 2 - ) 3 . ( 4 . alcohol is an obligation of all adherents ) 9 & . countries with predominantly Muslim incompatible with leading a 5.42 &3 abstainers (Partanen 53 - Similarly many adherents %)&2&.43 have 3high prevalence In Islam 02&% - . .4 9 alcohol is an obligation ofstrands 02&6 &. & population .% a 2&35 4holy life. of 7 4) abstaining from 1990).0 05 4 . ) 6& all) () of and as a result countries 34 .&23 also require with predominantly abstain population have a high prevalence 4)& 2 %)&2&.43 4 34 . - 2 9 - .9 342 .%3 alcohol. Christianity 24 .&. their adherents to Muslim from )2 34 . 49 3 2&15 2& of abstainers 2 - ) (Partanen 1990). Similarly many strands of Christianity also require their adherents to abstain from Consuming a large quantity of alcohol on a single occasion also known as binge drinking is alcohol. common among male drinkers in Africa . 3 .( & 3 .ranging from 7 per cent to 77 per cent .35- .( 2(& 15 .4 49 ) with the prevalence 3 . 7. 3 .(& %2 . .( 3 -- . (Clausen et al. 2009). Data from WHO 02&6 &. & 2 .( .( 2 - 0&2 &.4 4 - .( - & %2 . &23 . 2 7 4) on (2011) show that Sub-Saharan Africa has the highest rate of &4 0&2 is common Consuming a large quantity of alcohol 4)&a single occasion also known as binge drinking &.4 53&. binge drinking of any region at 3) 7 4) 4 of 25 ) 2 . 2 ) 3 4)& ) ()&34 2 4& .(& %2 . .( .9 an average 5 per cent compared to the global rate of 11.5 per 4 2 among male drinkers in Burkina Faso South Africa and Mozambique having the highest rates cent (WHO 2011) withAfrica with the prevalence ranging from 7% to 77% (Clausen et al. 2009). Data 2&( . 4 . 6&2 (& 0&2 &.4 -0 2&% 4 4)& ( 2 4& 0&2 &.4 7 4) (Figure 1). (2011) show that Sub-Saharan Africa has the highest rate of binge drinking of any region at from WHO 52 . 3 54) 2 .% - 15& ) 6 .( 4)& ) ()&34 2 4&3 (52& an average of 25% compared to the global rate of 11.5% (WHO 2011) with Burkina Faso South Africa and Mozambique having the highest Selected amoung Men in Selected Rates of Binge Drinking Among Men in rates (Figure 1). (52& 4&3 Countries 2 . .( - .( &. . & & 4&% 5 ) 2 . 2 . 5.42 &3 (Figure 1.) Sub-Saharan African .(& (2003-2008) 1.) (Figure Figure 1. Rates of Binge Drinking among Men in Selected Sub-Saharan African Countries (2003-2008) &- (2 0) )& 4) 3526&93 . 54) 2 3 .% 4& Source WHO 2011 4) 4 - 34 health 522&.4 ) Africa also %2 . Demographic 4) 2% surveys in South .35-&23indicate )& 6 9 6&2 third of current 7 4) 4)& ) ()&34 &6& that almost a 4)& 7&& &.%3 alcohol consumers drink .(& Demographic health surveys in South Africa also indicate that almostweekends with the highest .% &- &3 heavily over the - .( - &3 (&% consumers binge level of %2 . .( & .( a third of current alcohol drinking drinking being among males aged 35 44 . . . being among males aged 35 44 .% 6 .( (&%binge 7 4) 7 &6& 3 &%5 4 . and females drink heavily over the weekends with the highest level of aged 45 54 with low levels of education and living in non52 . 3&44 &-&.43 .3 . )&3& 2009). and females aged 45 54 with low levels of education and living in non-urban settlements (Donson &8 -0 &3 urban settlements - .9 5 2009). These examples %&- .342 4& 4) 4 (Donson ) 2 . 2 . 5.42 &3 These examples demonstrate that many Sub-Saharan African countries haveSub-Saharan Africanlifetime demonstrate that many a large proportion of countries ) 6& 2(& 02 0 24 . &4 -& 34 .&23 .% 35 3&4 abstainers and a subset of consumers who are heavy drinkers. proportion of lifetime abstainers and a subset have a large .35-&23 7) 2& )& 69 %2 . &23 of consumers who are heavy drinkers. As illustrated in Table 1 the types of alcohol consumed in the Sub-Saharan Africa vary between countries. 3 5342 4&% . & 4)& 490&3 alcohol consumed As illustrated in Table 1 the types of ) .35-&% . 4)& 5 ) 2 . 2 6 29between countries. Source WHO 2011 Beverages other than beer spirits and wine have the highest share in total recorded consumption. More in Sub-Saharan Africa varies &47&&. 5.42 &3 than 80% of 4)&2 4) . &&2 30 2 43 .% 7 .& ) 6& 4)& ) ()&34 3) 2& . 4 4 2& 2%&% .35-04 . 2& &6&2 (&3 alcohol consumed in East and West Africa are local brews and spirits while in Central and Beverages other than beer spirits and wine have the highest share in total recorded consumption. More 4) . 80 0&2 &.4 of alcohol consumed in East and West &34 2 to be the preferred drinks.while7) & . .% wine tend 2& 2&73 spirits These Southernper cent of alcohol consumed in East and West Africa are local brews and .% 30 2 43 in Africa the pattern is .35-&% . as than 80 per cent of alcohol consumed in East and West Africa are local brews and spirits while in than 80 per cent ) slightly different 34spirits and Africa are local brews and spirits while in than &.42 .% that alcohol consumption is common indifferent as spirits and wine but4&.% 4 & 4)& 02& &22&% 54)&2. Africa the pattern is slightly different as spirits and wine tend to be the preferred 2 the pattern is slightly Sub-Saharan African society tend to be the preferred 4)& 0 44&2. 3 3 ()4 9 % &2&.4 3 30 2 43 .% 7 .& there is data confirm Southern Africa the pattern is slightly different as spirits and wine tend to be the preferred Central and Southern Africa Central and Southern Central and %2 . 3 These data confirm that alcohol consumption is common inand5 ) 2 . 2 . 3 &49 54 4)&2& )&3& % 4 . 2- 4) 4 ) .35-04 . 3 -- . . socioeconomic differences considerable variability in drinking alcohol consumption is common in Sub-Saharan African society as there drinks. These data confirm that alcohol consumption is common in Sub-Saharan African society but there drinks. These data confirm that patterns between countries. Cultural but drinks. 3 .3 %&2 & 6 2 49 . %2 . .( 0 44&2.3 &47&&. 5.42 &3 Sub-Saharan African society % &2&. &3 5 452 .% 3 & . - but there well as the extentvariability in drinking patterns between countries. Cultural and socioeconomic of of alcoholin drinking patterns between countries. Cultural and socioeconomic differences advertising may explain the differences. This implies that the magnitude differences is considerable variability in drinking patterns between countries. Cultural and socioeconomic differences is considerable is 7& 3 4)& &84&.4 ) %6&24 3 .( - 9 &80 . 4)& % &2&. &3 ) 3 -0 &3 4) 4 4)& - (. 45%& 3 considerable variability consequences extent of alcohol advertising may explain& & 43 7 from country to country 5.429 .% of as well as the extent of alcohol advertising may explain the differences. This implies that the magnitude of as well as the of drinking alcohol and the associated effects will differ % &2 2 - 5.429 4 and even .3&15&. &3extent of alcohol advertising may explain the differences. This implies that the magnitude of as well as the %2 . .( ) .% 4)& 33 4&% the differences. This implies that the magnitude within different regions in thealcohol and the associated effects will differ from country to country and consequences of drinking alcohol and the associated effects will differ from country to country and consequences of drinking same country. consequences of drinking alcohol and the associated effects will differ from country to country and even within different regions in the same country. 30 Table 1. Types of Alcohol Consumed in Sub-Saharan African Table 1. Countries (2003-2005) Countries (2003-2005) Table Types ofof Alcohol Consumed in African Countries (2003-2005) 1. Types Alcohol Consumed Region Country % Adults ( 15 Years) Who Drink % Consumption by Type of Alcohol (in % of Pure Alcohol) Beer Spirits Wine Other West Africa 649 Burkina Faso 0949 Benin 0 H A 4 0 Cote d Ivoire Gambia (the) &30 8-4 Gambia 3 9 Ghana 4-0 4 Liberia 74 Mali 420 4 Nigeria %0902 7 Senegal %40 0 90 Sierra Leone & 2 Togo 23.9 48.5 23.7 n a 29.4 n a 2.8 38.3 2 39.1 n a 45.3 48.1 n a 21.1 88 43.7 n a 68 n a n a 39.3 27.7 14.6 n a 21.2 43.8 38 30 1 34.2 29.7 19.2 46.4 43.6 20.4 87.2 27.1 25.8 16.1 14.4 9 45 14 8 27 9 13 6 54 7 42 44 14 13 56 5 16 10 22 7 19 68 33 44 8 11 4 24 57 64 64 44 13 73 36 67 85 56 33 18 25 9 14 1 2 2 91 2 1 3 1 6 1 6 2 5 1 1 1 10 14 1 32 22 27 1 3 2 29 1 27 1 43 20 15 55 20 4 16 3 12 2 2 13 7 2 5 1 1 1 43 1 31 1 80 1 2 7 1 90 21 1 1 1 1 1 1 1 9 1 9 1 13 1 12 6 7 11 17 4 1 5 80 28 78 88 66 85 94 93 21 55 84 37 83 55 81 43 28 92 86 94 Central Africa 80 9 Cameroon 0 (0 0 Cape Verde Central African Republic (the) &30 09 7African Republic Central 1 4. 9 0 -74. 3 Chad Congo (the) &30 92 Congo 39 Democratic DR 08 . 4.Republic of 1 Congo Congo 0 -74. the 92 4 7 490 Equatorial Guinea - 9 Gabon n a 490 4 Guinea Bissau Eastern Africa 9 4 Burundi 4 0 Eritrea 34 4 Ethiopia 09D Kenya B 9 Rwanda 94 0 0 -74. 1 & 9E 94 Tanzania 2 9 Uganda Southern Africa 92 7 Angolan a B 9 Botswana Comoros (the) &30 8 Comoros 0 3 Lesotho 2 . Madagascar 7 B4 Malawi 4 4 Mauritius E 8-4 0 Mozambique 84-4 Namibia %0D.30770 Seychelles % 3 1 4. South Africa %B E47 9 Swaziland 8-4 Zambia 48- -B0 Zimbabwe Source WHO 2011 42 36 67 3 6 11 60 70 68 w www.icap.org e info icap.org e 0 Magnitude of Alcohol-Related Road Crashes Alcohol-Related Road Crashes been conclusively identified as a major risk factor for all types of fatal road Alcohol has been conclusively identified as a major risk factor for all types of fatal road (WHO 2004). However in Sub-Saharan Africa such data are available for traffic injuries (WHO 2004). However in Sub-Saharan Africa such data are available for countries. A review of studies conducted in low- and middle-income countries only a few countries. A review of studies conducted in low- and middle-income countries shows that alcohol affects all road users but with considerable variation between alcohol affects all road users but with considerable variation between countries (Odero & Zwi 1995). In South Africa tests for blood alcohol concentration countries (Odero & Zwi 1995). In South Africa tests for blood alcohol concentration (BAC) conducted on transport-related deaths between 2002 and 2008 show that (BAC) conducted on transport-related deaths between 2002 and 2008 show that pedestrians are the most likely to be BAC-positive (59%-63%) followed by drivers pedestrians are the most likely to be BAC-positive (59 per cent-63 per cent) followed by drivers passengers and cyclists (Table 2). Pedestrians also had the highest mean BAC level passengers and cyclists (Table 2). Pedestrians also had the highest mean BAC level (0.21 g dl). This trend remained consistent over the years reviewed. (0.21 g dl). This trend remained consistent over the years reviewed. Table 2. Incidence of Alcohol-Related Fatal Injuries in Table 2. Alcohol-Related Fatal Injuries in South Africa 2002-2008 South Africa 2002-2008 Alcohol-Related Fatal Injuries % 2002 2004 2007 2008 Mean BAC g dl Source Donson 2009 Pedestrians 59 60 59 63 0.21 Drivers 55 51 56 58 0.17 Passengers 41 40 56 45 0.13 Cyclists 37 39 42 43 0.16 Evidence of presence of blood alcohol among non-fatally injured crash-involved road Evidence of presence of blood alcohol among non-fatally injured crash-involved road users has also been reported in a few studies conducted in South Africa and Kenya. A users has also been reported in a few studies conducted in South Africa and Kenya. A hospital-based study in Cape Town found that 61.2% injured pedestrians were BAC hospital-based study in Cape Town found that 61.2 per cent injured pedestrians were BAC positive (Peden et al. 1996) while in Kenya a similar study reported the presence of positive (Peden et al. 1996) while in Kenya a similar study reported the presence of blood alcohol in 60% ofcent of drivers 33 per cent of and 8.3% of pedal cyclists involved blood alcohol in 60 per drivers 33% of pedestrians pedestrians and 8.3 per cent of pedal in road crashes (Odero crashes (Odero 1998). The study showed that males were twice as cyclists involved in road 1998). The study showed that males were twice as likely as females to have been drinking drinking the crash and most of most of the intoxicated subjects likely as females to have been prior to prior to the crash and the intoxicated subjects were injured in crashes that occurred at night and during weekends. These data though occurred at night and during weekends. These data though were inconclusive inconclusive reflect the magnitude of alcohol use among different road users irrespective magnitude of alcohol use among different road users irrespective of injury outcomes and imply that measures for preventing alcohol-related crashes on injury outcomes and imply that measures for preventing alcohol-related crashes should target all road users. should target all road users. Prevention of Alcohol-Related Crashes Involving Prevention of Alcohol-Related Crashes Involving Vulnerable Road Users Vulnerable Road Users Effectiveness of introducing BAC limits for drivers has been shown to lead to reductions inin of introducing BAC limits for drivers has been shown to lead to reductions impaired driving and alcohol-related crashes. The World Report on Road Traffic Injury driving and alcohol-related crashes. The World Report on Road Traffic Injury Prevention (Peden et World Bank 2004) recommends a of 0.05 g dl 0.05 g dl for the Prevention (WHO andal 2004) recommends a BAC limit BAC limit of for the general general driving population and 0.02 g dl for young drivers and motorcycle riders. In Sub-Saharan driving population and 0.02 g dl for young drivers and motorcycle riders. In Sub-Saharan Africa although 42countries have a national drink-driving law there is wide variation in the Africa although 42 countries have a national drink-driving law there is wide variation in the maximum legal limits ranging from 0.01 to 0.08 g dl and half of the countries have limits maximum legal limits ranging from 0.01 to 0.08 g dl and half of the countries have limits in excess of 0.05 g dl (Jacobs Thomas & Astrop 2000). Nine countries (Benin Eritrea in excess of 0.05 g dl (Jacobs Thomas & Astrop 2000). Nine countries (Benin Eritrea 32 Democratic Republic of Congo Liberia Mali Mauritius Nigeria South Africa and Swaziland) have BAC limits for drivers consistent with the recommendations of the report and only one country has an effective enforcement of drink-driving law. Most Sub-Saharan African countries lack enforcement for several reasons including The traffic police lack items such as breathalyzers and booze buses to routinely The traffic police lack equipment such even in countries where a buses to limit monitor drivers blood alcohol levels as breathalyzers and boozelegal BACroutinely monitor drivers blood alcohol levels even in countries where a legal BAC limit exists. exists. The traffic police are not adequately trained toto administer alcohol tests. traffic police are not adequately trained administer alcohol tests. There is no legal requirement for the police toto do random breath tests drivers There is no legal requirement for the police do random breath tests of of drivers and pedestrians who are not involved inin a crash. pedestrians who are not involved a crash. There is a general lack of enforcement laws to control the production There is a general lack of enforcement ofof laws to control the production promotion and sale of alcohol inin most countries. promotion and sale of alcohol most countries. The lack of mechanisms for ascertaining the prevalence of impaired driving means that these countries cannot monitor progress in preventing alcohol-related crashes. It is imperative that all countries adopt and implement the recommended BAC limits of 0.05 g dl for the general population and 0.02 g dl for novice drivers. Whereas setting and enforcing BAC limits for drivers is highly feasible reducing alcohol consumption among pedestrians is more complex and currently there are no effective practical solutions. Since walking is a normal life activity considered to be carrying no particular hazard and alcohol is also widely used as a culturally accepted way of life in many societies multifaceted context-specific strategies addressing both alcohol consumption and walking are needed. In addition to the range of interventions for specific risk factors for road crashes involving vulnerable road users highlighted by Constant and Lagarde (2010) and those recommended in the recently released manual on pedestrian safety (WHO 2013b) the following strategies focusing on alcohol consumption in the general population require serious consideration and testing. w www.icap.org e info icap.org 0 Awareness and Awareness and Behavior Behavior Change Change Evidence from systematic reviews indicates that pedestrian safety education can change road-crossing behavior (Duperrex Roberts & Bunn 2002). Yet awareness and prevention campaigns have remained relatively scarce among pedestrians and cyclists so many are unaware of road hazards while some consider that crash avoidance is up to motorists only. Pedestrians and cyclists should therefore be informed and encouraged to obey the same rules as drivers of motor vehicles with regard to risky behaviors including excessive alcohol consumption. Through advertisements in both print and electronic media anti-alcohol campaigns giving clear messages to the general public emphasizing that drinking is a risk not only for motor vehicle drivers but also for all road users could be enhanced. The Drive Alive national road safety campaign in South Africa which targets drivers pedestrians and passengers is a good example of a comprehensive campaign containing messages on key safety areas drinking and driving speeding jaywalking visibility and alighting and crossing are also increasingly being advocated in South Africa (Arrive Alive). Publicity materials on on these issues widely distributed to to community level Alive n.d.). Publicity materialsthese issues are are widely distributedcommunity level the Department of Transport. by the Department of Transport. Workplace education of employees on the consequences of excessive drinking Workplace education of employees on the consequences of excessive drinking introducing new codes of conduct emphasizing zero tolerance for alcohol asas well as introducing new codes of conduct emphasizing zero tolerance for alcohol well as setting higher standards of behavior could also help inin changing behavior in specific setting higher standards of behavior could also help changing behavior in specific working situations. Another approach could be the application ofof positive deviance working situations. Another approach could be the application positive deviance theory built on the premise that in every community there are certain individuals whose theory built on the premise that in every community there are certain individuals whose uncommon practices or behaviors enable them to find successful solutions toto problems uncommon practices or behaviors enable them to find successful solutions problems more often than others in the same community who have similar problems (Bradley more often than others in the same community who have similar problems (Bradley et et al. 2009). For example using people in in the community who previously drankheavily al. 2009).For example using people the community who previously drank heavily and have stopped drinking and are now leading happier and more prosperous life as and have stopped drinking and are now leading aa happier and more prosperous life as champions for change in alcohol consumption can help to influence behavior change champions for change in alcohol consumption can help to influence behavior change from alcohol misuse to moderate consumption or abstinence. from alcohol misuse to moderate consumption or abstinence. Engagement of Stakeholders Engagement of Stakeholders There is a need to encourage and engage multiple actors including those in the alcohol industry law enforcement religious organizations civil society and local community as well as legal and health professionals to address the problem of alcohol-related crashes. In particular involving religious leaders in informing and persuading their followers to adhere to prohibitions on alcohol is a potential but untested strategy that could be used to reduce hazardous alcohol consumption in the society. 34 Alcohol Controls Alcohol Controls There is need to identify and build on certain aspects of alcohol controls such as advertising restrictions serving alcohol at sports venues and having alcohol outlets near schools that already have the backing of the general public. In most Sub-Saharan African countries it is not the lack of laws to control alcohol--since many have laws on licensing packaging hours of sale and a legal age for drinking--but the lack of enforcement of these laws that is the problem. Efforts to introduce such controls have been made in Kenya through an Act of Parliament (Government of Kenya 2009) but some aspects faced stiff opposition from some parts of the alcohol industry. Strict enforcement of alcohol controls should be prioritized. Further as the supply of alcohol is often beyond governmental control and therefore many standard policy instruments will not be applicable or available to address the issues it is important to keep abreast of best practices in alcohol controls and to consider their application within the relevant national context. Legislation Legislation Comprehensive legislation is a key element of safety of all road users but legislation alone is not likely to facilitate behavior change in the absence of law enforcement and deterrent penalties. Compliance with laws is critical and should be accompanied by an effective law enforcement system. Establishing legislation setting a legal limit for pedestrians would pose a significant challenge to enforce given that countries are already unable to enforce the existing drink-driving laws. w www.icap.org e info icap.org 0 Conclusions Sub-Saharan Africa bears the greatest burden of road traffic crashes in the world and Sub-Saharan Africa bears the greatest burden of road traffic crashes in the world and has the highest road has the highest road fatality rate but the rates vary between countries. fatality rate but the rates vary between countries. Vulnerable road users are the most affected and account for more than half of all road Vulnerable road users killed. users are the most affected and account for more than half of all road users killed. cultural and social activities and Historically Historically homemade brews played an important role inin cultural and social activities were an homemade brews played an important role integral part of traditional African lifestyle. and were an integral part of traditional African lifestyle. A gradual A gradual change in alcohol use from socialization to commercial purposes occurred following the change in alcohol use from socialization to commercial purposes occurred introduction of European types of alcohol. following the introduction of European types of alcohol. The prevalence low in most countries and is mostly The prevalence of alcohol consumption in the general population isis low in most influenced by religion gender and advertising. general population of alcohol consumption in the countries and is mostly influenced by religion gender and advertising. The rate the global rate. The rate of binge drinking is higher in the region compared toto the global rate. of binge drinking is higher in the region compared Pedestrians have been drinking and have Pedestrians involved in fatal road crashes are more likely toto have been drinking and higher blood alcohol levels comparedfatal road crashes are more likely involved in to drivers. have higher blood alcohol levels compared to drivers. Recommendations Data on alcohol-related crashes are limited and inadequate for planning and monitoring road safety Data on alcohol-related crashes should planninginadequate for planning and interventions. crashes are limited collated and analyzedroadplanning and for be and and monitoring for safety Data on monitoring road safety interventions. road safety interventions. interventions. monitoring Countries with BAC limits above the recommended level of 0.05 g dl should change Countries with BAC limits above the recommended level of 0.05 g dl should change Countries the BAC limit level tolimits above the recommended level of 0.05 g dl should change the BAC limit level to g dl. Countries with BAC 0.05 above the recommended level of 0.05 g dl should change the BAC limit level to 0.05 g dl. 0.05g dl. the BAC limit level to 0.05 g dl. To make progress in reducing alcohol-related crashes countries must improve their enforcement of drink-driving laws. To To make progress in reducing alcohol-related crashes countries must improve their To make progress in reducing alcohol-related crashes countries must improve their enforcement of reducing alcohol-related crashes countries must improve their enforcement of drink-driving laws. enforcement of drink-driving laws. drink-driving laws. Countries should introduce a range of sustainable multifaceted strategies for reducing alcohol consumption in the a range of sustainable multifaceted strategies for reducing alcohol Countries Countries should introduce general population. introduce a range of sustainable multifaceted strategies for reducing Countries should introduce a range of sustainable multifaceted strategies for reducing alcohol consumption in the general population. alcohol consumption in the general population. consumption in thefor anti-drink driving campaigns and measures is warranted Enhanced support general population. particularly support for anti-drink driving of binge drinking measures is warranted South Enhanced Enhanced support for anti-drink drivingcampaigns and measuresBurkina Faso particularly in countries with high rates campaigns and such as is warranted Enhanced in countriesanti-drink driving campaigns and measures is warranted particularly in countries with high rates of binge drinking such as Burkina Faso South Africa and Mozambique. highsuch as Burkina Faso South Africa and Mozambique. particularly in countries with with high rates of binge drinking rates of binge drinking such as Burkina Faso South Africa and Mozambique. Africa and Mozambique. References Acuda S. W. (1985). International review series Alcohol and alcohol problems research. British Journal of Addiction 80 121-126. Arrive Alive 10 years of online road safety awareness [Website]. (n.d.). Available http www.arrivealive.co.za Bradley E. H. Curry L. A. Ramanadhan S. Rowe L. Nembhard I. M. & Krumholz H. M. (2009 May 8). Research in action using positive deviance to improve quality of health care. Implementation Science 4(25) doi 10.1186 1748-5908-4-25 Clausen T. Rossow I. Naidoo N. & Kowal P (2009). Diverse alcohol . drinking patterns in 20 African countries. Addiction 104 1147-1154. Constant A. & Lagarde E. (2010). Protecting vulnerable road users from injury. PLoS Medicine 7(3) e1000228. doi 10.1371 journal.pmed.1000228 Donson H. (2009). A profile of fatal injuries in South Africa 2008 Annual report for South Africa based on the National Injury Mortality Surveillance System. Johannesburg Medical Research Council. Duperrex O. Roberts I. & Bunn F. (2002). Safety education of pedestrians for injury prevention. Cochrane Database Syst Rev CD001531. doi 10.1080 00140139008925332 Ebie J. C. (1990). The use of different alcoholic beverages in two urban areas of Nigeria. In J. Maula M. Lindblad C. Tigerstedt & L. GreenRutanen (Eds.) Alcohol in developing countries Proceedings from a meeting in Oslo Norway August 7-9 1988 (NAD Publication No. 18 pp. 168-184). Helsinki Nordic Council for Alcohol Research (NAD). Government of Kenya. (2009). The Alcoholic Drinks Control Bill 2009-- Mututho Law (Kenya Gazette Supplement No. 70). Nairobi Author. Jacobs G. Thomas A. A. & Astrop A. (2000). Estimating global road traffic fatalities (TRL Report 445). Crowthorne Transport Research Laboratory. Available http www.transportlinks.org transport_links filearea publications 1_329_TRL445.pdf Maula J. (1990). Research in the production and consumption of alcohol in Tanzania. In J. Maula M. Lindblad C. Tigerstedt & L. GreenRutanen (Eds.) Alcohol in developing countries Proceedings from a meeting in Oslo Norway August 7-9 1988 (NAD Publication No. 18 pp. 193-205). Helsinki Nordic Council for Alcohol Research (NAD). Odero W. (1998). Alcohol-related road traffic injuries in Eldoret Kenya. East African Medical Journal 75(12) 708-711. Odero W. O. & Zwi A. B. (1995). Alcohol-related traffic injuries and fatalities in developing countries A critical review of literature. London London School of Hygiene and Tropical Medicine. Pan L. (1975). Alcohol in colonial Africa. Uppsala Scandinavian Institute of African Studies. 36 Biography Mr W ilson Odero Africa Presenter M r. E r i c H o w a r d Pr incipa l Dr. W ilson Odero is a Professornof P ublic Health s u l t icurreP t y Ded of W h i t i g M o y n e C o n and n g ntly L t an the r. W i l s o n O d e r o i s aat Ao s o cria tUniversity oKenya.D e a n S c h o o lhis School of Med icine nM s d e a te r r o f e s s r a n d He obtained o f Maseno o P D D r. W i l s o n O d e r o A f ri c a Pr es e nt er MDuatl ithe Minsk StateUMe dicalt y K e n y a .in 1979 eandhlater o r k e d P b c H e a l t h M o i n i v e r s i Institute D r. O d r o a s w completed MSc and PhD at the Lond on School of Hygiene and Tropical Medicine. e t e n ro has b c o involve o in o t a dr gsety ea P r i n c s ac o faW h i tH O a n dy n e a t c H road i t i t i o arch l s W ing M Dr. xOdes i v e l y i n eenl l a b o rE r iid n w iwh rosafa nhz resen s i puinhcollaborationo with a S t r a t e g i c D F I D o n ofanational a f f i cRinternational A d v ianizations u l tp rnpublishedt i n g i n t e r n a t i o n a l l y. v r i o u s t r and io au r y ae e t ya rorg a n dyt rC on i s g a oc yr a me r a n j d S r f s e c h s o r a i n n and g o p s . a number wide ly on the subject especially finr m evey G e n ecountries. e r R o a d S a f e t y w i t h V i c R o a d s E r i c i s o de r l loping r a l M a n a g As a temporary consultant to the WHO s De partme nt of Violence and P r e v e n t i o n h e w o r k e d A u v aa il o u sHi n j u r y n rie ve r n a i o a n d cro n to o ln i s e d o n tr r i a. p e ntio n r Injury Prevention on d ive rsesperiod s e i scontribute d tto n a l l ydevelop ment e x p e r t o n t h e he a n t the e c g pseveral injury d i n g w o rs t r e n g nh t h e np r e p a r a td s aoe tty e WntheeWorld rc a p a c i t y w i t h i n r o j e c t s i n c l u preventionnandt control materials including oa g me p o t ki g o en i g o f ro a io n f f h m a r ld R en t of o n Tr on Road i e s . D . g o vs s m e n tr o n d r h njury seurveillance Guidelines W i l e rn Od e a cu t e de l op s a s h Report a f f i c I n j u rTraff ic rInjurieo n Community rIe n t l y vSe r v em e n t to fep r a c t i c a l e f f e c t i v e r o a d and c r e t Ped estrianaS afe t h e I n j u r y P r e v e n t i o n I n i t i a t i v e f o r A f ryears as S e the a r y G e n e r l o f ty a f e t y p o lHeealso served e g i e s i n v o l v iic a . r e l e v a n t s t a k e h o l d e r s . s Manual. i c i s a n d s t r a t for several n g the Secretary Ge ne ral of the Injury Pre ve ntion Initiative f or Af rica (IPI FA) and Board member of the Road Traffic I njury Research Ne twork (RTIRN). A s a c o n s u l t a n t t o t h e tWe S t a t e e p a rd m e ne to f A go ln c y eRa n d I A ju tr yo r i t y i n V i c t o r i a h H O s D Ro a t Sa f t y V i e e nc oa d n u h Click toClick to download the full download the full presentation Dr Wilson Odero presentation for the 2013 Mr Wilson Odero provided for the 2013 United Nations Global Road safety Week United Nations Global Road SafetyWeek Partanen J. (1990). Abstinence in Africa. In J. Maula M. Lindblad C. Tigerstedt & L. Green-Rutanen (Eds.) Alcohol in developing countries Proceedings from a meeting in Oslo Africa. In J. Maula M. Lindblad C. Partanen J. (1990). Abstinence in Norway August 7-9 1988 (NAD Tigerstedt 18 pp. 70-85). Helsinki Alcohol in developing countries Publication No.& L. Green-Rutanen (Eds.) Nordic Council for Alcohol Proceedings Research (NAD).from a meeting in Oslo Norway August 7-9 1988 (NAD Publication No. 18 pp. 70-85). Helsinki Nordic Council for Alcohol Peden M. M. Knottenbelt J. D. van der Spuy J. Oodit R. Scholtz H. Research (NAD). J. & Stokol J. M. (1996). Injured pedestrians in Cape Town--The role Peden M. M. Knottenbelt J. D. van der Spuy J. Oodit R. Scholtz H. of alcohol. South African Medical Journal 86(9) 1103-1105. J. & Stokol J. M. (1996). Injured pedestrians in Cape Town--The role Room alcohol. South D. H. Carlini-Marlatt B. Gureje O. Makela K. of R. Jernigan African Medical Journal 86(9) 1103-1105. Marshall M. et al. (2002).H. Carlini-Marlatt B. Gureje O. Makela K. Room R. Jernigan D. Alcohol in developing societies A public health approach. et al. (2002). Alcohol in developingAlcohol Studies and Marshall M. Helsinki Finnish Foundation for societies A public health approach. Helsinki World Health Organization. Finnish Foundation for Alcohol Studies and World Health (1990). The Silberschmidt M.Organization. interaction between changing male and Silberschmidt M. (1990). The interaction between J. Maula M. female roles and alcohol problems in rural Kenya. Inchanging male and female roles and alcohol problems in rural Kenya. In J. Maula M. Lindblad C. Tigerstedt & L. Green-Rutanen (Eds.) Alcohol in Lindblad C. Tigerstedt & L. Green-Rutanen (Eds.) Alcohol in developing countries Proceedings from a meeting in in Oslo Norway developing countries Proceedings from a meeting Oslo Norway August 7-9 7-9 1988 (NAD Publication No. 18 pp. 134-150).Helsinki August 1988 (NAD Publication No. 18 pp. 134-150). Helsinki Nordic Council for Alcohol Research (NAD). Nordic Council for Alcohol Research (NAD). World Health Organization Regional Office for Africa (WHO AFRO). World Health Organization Regional Office for Africa (WHO AFRO). (2009). Status report road safety in countries of the WHO African (2009). Status report on on road safety in countries of theWHO African Region. Brazzaville Author. Region. Brazzaville World Health Organization Regional Office for Africa (WHO AFRO). (2013). Road safety in the WHO African Region--The facts 2013. Available http www.afro.who.int en clusters-aprogrammes World Health Organization Regional Office for Africa (WHO AFRO). (2013). Road safety in the WHO African Region--The facts 2013. dpc mental-health-violence-and-injuries features 2846Available http www.afro.who.int en clusters-astatus-report-on-road-safety-in-countries-of-the-who-african-region.html programmes dpc mental-health-violence-and-injuries features 2846World Health Organization (WHO). (2004a). World report on road traffic status-report-on-road-safety-in-countries-of-the-who-african-region.html injury prevention. Geneva Author. World Health Organization (WHO). World Health Organization (WHO). (2004a). World report on road traffic (2004b). Global Geneva Author. alcohol and Organization (WHO). injury prevention. status report on World Healthhealth. Geneva World Health Organization (WHO). (2011). health. status report on (2004b). Global status report on alcohol and Global Geneva Author alcohol and Organization (WHO). (2011). Global status report on World Healthhealth. Geneva. World and health. Geneva Author. alcoholHealth Organization (WHO). (2013a). Global status report on road Health Organization (WHO). (2013a). Global status report on Worldsafety. Geneva. road safety. Geneva Author. (WHO). (2013b). Pedestrian safety A road World Health Organization safety manual for decision-makers and practitioners. Geneva. World Health Organization (WHO). (2013b). Pedestrian safety A road safety manual for decision-makers and practitioners. Geneva Author. Yguel J. S. Luciani S. Duflo B. M Bamezoui C. Froment A. Bard Yguel al. S. Luciani S. Duflo B. M Bamezoui C. Froment A. Bard parts D. et J. (1990). Consumption of alcoholic drinks in three different D. Cameroon. In J. Maula M.of alcoholicC. Tigerstedt & L. Greenof et al. (1990). Consumption Lindblad drinks in three different parts of Cameroon. In J. Maula M. Lindblad C. Tigerstedt & L. GreenRutanen (Eds.) Alcohol in developing countries Proceedings from a Rutanen (Eds.) Alcohol in developing countries Proceedings from a meeting in Oslo Norway August 7-9 1988 (NAD Publication 18 meeting in Oslo Norway August 7-9 1988 (NAD Publication No.No. 18 113-126). Helsinki Nordic Council for Alcohol Research (NAD). pp. 113-126). Helsinki Nordic Council for Alcohol Research (NAD). w www.icap.org e info icap.org 0 European n R e g i o n - P e r s p e c t i v e s o n E u r o p e a Region - Perspectives EuropeanRegion - Perspectives on on Preventing Alcohol-Relateda t e d R o a d C r a s h e s P r e v e n t i n g Alcohol-Related Road Crashes A l c o h o l - R e l Road Crashes Preventing Involving g Vu l n e r a b l e R UsersU s e r s I n v o l v i n Vulnerable Road o a d Involving Vulnerable Road Users M s M a j d Zorec Karlovsek Dr. Majda a Z o r e c K a r l o v s e k University of Ljubljana Medical Faculty Institute of Forensic Medicine Korytkova 2 1000 Ljubljana Slovenia Email mzkarlovsek gmail.com This paper discusses drink driving issues in Europe and Central Asia. This is not a homogenous region. In addition to the wide variations in their economic development (which is often translated into different levels of motorization availability and availability and quality of road infrastructure) historic cultural and religious cultural and religious differences shape their traffic safety situation and particularly the level of severity of drink driving. Europe - Slovenia Table 1. Income Groups of the WHO European Region 2004 Table 1. Income Groups of Europe and Central Asia 2004 World Bank Income group High Member States Vehicles Andorra Austria Belgium Cyprus Denmark Finland France Germany Greece Iceland Ireland Israel Italy Luxembourg Malta Monaco Netherlands Norway Portugal San Marino Slovenia Spain Sweden Switzerland United Kingdom Croatia Czech Republic Estonia Hungary Latvia Lithuania Poland Russian Federation Slovakia Turkey Albania Armenia Azerbaijan Belarus Bosnia and Herzegovina Bulgaria Former Yugoslav Republic of Macedonia Georgia Kazakhstan Montenegro Romania Serbia Turkmenistan Ukraine Kyrgyzstan Republic of Moldova Tajikistan Uzbekistan Number of States 25 Percentage of All States 47.2 Upper middle Lower middle 10 14 18.9 26.4 Low Source WHO 2013 4 7.5 38 Road Crashes and Injuries A total of 92 492 people died in 2010 from road traffic injuries in Europe and Central A totalwith92 492 people deaths 2010 from in low- and injuries in Europe and Central Asia of 66% of these died in occurring road traffic middle-income countries (Mitis Asia with 66 per cent of these deaths occurring in low- and middle-incomehas the (Mitis & Sethi 2013). With 10.3 road deaths per 100 000 population the region countries & Sethi rate in the world however it has the highest instance of inequalities in road lowest 2013). With 10.3 road deaths per 100 000 population the region has the lowest fatality rates (see however it has the highest instance of inequalities in road traffic rate in the world Table 1). traffic fatality rates (see Table 1). The safest countries in Europe and Central Asia are safest countries in Europe and Central Asia are The high-income countries Iceland (2.4 deaths per high-income countries 100 000 population) Sweden (2.8) the United Iceland (2.4 deaths per 100 000 population) Sweden (2.8) the United Kingdom (3.0) Kingdom (3.0) the Netherlands (3.8). The countries with the highest numbers of Malta (3.6) and Malta (3.6) and the Netherlands (3.8). The countries with the highest are Kazakhstan (21.1) the Russian Federation road fatalities per 100 000 inhabitantsnumbers of road fatalities per (16.4) Georgia (15.4) and Montenegro (15.0) (WHO 2013). (18.6) Kyrgyzstan 100 000 inhabitants are Kazakhstan (21.1) the Russian Federation (18.6) (Figure 1). Kyrgyzstan (16.4) Georgia car occupants comprise In Europe and Central Asia (15.4) and Montenegro 50 per cent of road fatalities (15.0) (Figure per pedestrians 271). cent motorcyclists 12 per cent cyclists 4 per cent and others 7 per cent (WHO 2013). Except Andorra Monaco San Marino and Turkmenistan. In Europe and Central Asia car occupants Source WHO 2013 comprise 50% of road fatalities pedestrians 27% The percentage of pedestrian road fatalities is the lowest in Luxembourg (3 per cent) (Figure 2). motorcyclists 12% cyclists 4% and others (7%) followed by the Netherlands (11 per cent) Belgium (11 per cent) Sweden (12 per cent) (WHO 2013). and Norway (12 per cent). The countries with the highest percentage of pedestrian traffic fatalities are Armenia (44 per cent) Slovakia (44 per cent) Tajikistan (42 per cent) The percentage of pedestrian road fatalities is the Belarus (41 per cent) and Ukraine (38 per cent) (WHO 2013). lowest in Luxembourg (3%) followed by the Netherlands (11%) Belgium (11%) Sweden (12%) The percentage of road fatalities among cyclists is in the range of 0 13 per cent except and Norway (12%). The countries with the highest in the Netherlands (25 per cent) where cycling is very popular (WHO 2013). Andorra percentage of pedestrian traffic fatalities are Armenia Iceland and Malta report that cyclists account for less than 1 per cent of all road Armenia (44%) Slovakia (44%) Tajikistan (42%) fatalities. In Azerbaijan Georgia Kyrgyzstan Kazakhstan Ireland Montenegro and Greece Belarus (41%) and Ukraine (38%) (Figure 2). the percentage of cyclist fatalities is about 1 per cent. Except Andorra Monaco Turkmenistan Uzbekistan and San Marino. Source WHO 2013 The percentage of road fatalities among cyclists is in the range of 0 13% except in the Netherlands (25%) where cycling is very popular (Figure 3). Andorra Armenia Iceland and Malta report that cyclists account for less than 1% of all road fatalities. In Azerbaijan Georgia Kyrgyzstan Kazakhstan Ireland Montenegro and Greece the percentage of cyclist fatalities is about 1%. (Figure 3). Except Monaco Turkmenistan Uzbekistan and San Marino. Source WHO 2013 w www.icap.org e info icap.org 0 Fatalities among motorcyclists are a huge problem and often contribute a significant part to the national road fatality statistics particularly in Mediterranean countries such as Cyprus (35 per cent) Greece (31 per cent) Italy (30 per cent) Malta (27 per cent) Portugal (24 per cent) and France (24 per cent). In Armenia Azerbaijan Georgia and Tajikistan motorcyclists account for less than 1 per cent of road traffic fatalities (WHO 2013). At the regional level the rates of road crashes with injuries have marginally decreased over the past three decades and the rates of accidents involving alcohol are decreasing across the entire region despite fluctuations at country level (Mitis & Sethi 2013). The reported involvement of alcohol in road fatalities in 2010 was on average 18.9 per cent and ranged from 1 per cent in the Former Yugoslav Republic of Macedonia to 43 per cent in Cyprus and 59 per cent in Kyrgyzstan (WHO 2013). The prevalence of alcohol and other drug use among the driving population was assessed in 12 European countries (Belgium the Czech Republic Denmark Spain Italy Lithuania Hungary the Netherlands Poland Portugal Finland and Norway) based on the results of roadside surveys carried out between January 2007 and July 2009 within the framework of the DRUID (Driving Under the Influence of Drugs Alcohol and Medicines) project. Alcohol (BAC 0.01 per cent) was the psychoactive substance most frequently detected in the general driving population (in the range of 0.15 8.59 per cent of a country s drivers with a mean across 12 countries of 3.5 per cent). Alcohol in concentration above the legal limit ( 0.05 per cent) was detected in 1.5 per cent of the driving population ranging from 0.07 per cent to 5.23 per cent. The highest prevalence of alcohol was found in drivers in the southern countries of Europe (EMCDDA 2012). Drink driving is overrepresented in road traffic crashes but only a few countries systematically test the blood alcohol levels of road users involved in crashes. Therefore it is uncertain whether the reported data about alcohol-related road fatalities in many countries in the region is an accurate representation of the situation. In Slovenia alcohol testing for drivers and other traffic participants who have caused an accident resulting in injury or major vehicle damage is mandatory more than 74 per cent of other fatally injured traffic participants are also tested (Zorec Karlovsek et al. 2002). From 2006 to 2010 drivers in Slovenia with a BAC above 0.05 per cent were involved in 10.1 12.6 per cent of all traffic accidents. However in road crashes with fatalities the percentage of alcohol-impaired drivers ranged from 30.3 per cent to 37.3 per cent (Republic of Slovenia Police). 40 Traffic injuries and deaths because of alcohol-related crashes are only one problems alcohol-related morbidity and mortality. The composition of social and healthpart of alcohol 6& .( .3 96. 7 &3) ) &8-7 (&97 4 &1(4-41 6 1&8 ) (6&7- 7 &6 431 43 5&68 4 related morbidity particular country or region is of social the drinking patterns and from drinking in anyand mortality. The composition related toand health problems from total &1(4-41 6 1&8 ) 246 .).8 &3) 2468&1.8 - (42547.8.43 4 74(.&1 &3) - &18- 564 1 27 642 drinking in any particular country or region is related to the drinking patterns and total amount consumed. )6.30.3 .3 &3 5&68.(91&6 (49386 46 6 .43 .7 6 1&8 ) 84 8- )6.30.3 5&88 637 &3) 848&1 amount consumed. &24938 (43792 ) The countries in Europe and Central Asia have the highest alcohol consumption per The countries in Europe and Central Asia have the highest alcohol consumption per capita capita (APC) in the world at 12.2 liters per adult. Total APC listed in Table 2 includes - (49386. 7 .3 9645 liters 386&1 7.& -& 8- -. - 78 &1(4-41 (4379258.43 5 6 (APC) in the world at 12.2&3) per adult. Total APC listed in Table 2 includes recorded (&5.8& recorded sales as well as legal and illegal unrecorded consumption (WHO 2011). The .3 8- 461) and 1.8 67 5 6 &)918 48&1 1.78 ) .3 & 1 .3(19) 7 6 (46) ) sales as well as legal&8 illegal unrecorded consumption (WHO 2011). The lowest adult lowest adult per capita consumption is in Israel (2.3 l) followed by countries with a 7&1 7 &7 consumption is in Israel (2.3 l) followed by countries with a majority Muslim &)918 - 14 78 per capita 11 &7 1 &1 &3) .11 &1 936 (46) ) (4379258.43 majority Muslim population (Turkey Tajikistan Uzbekistan Turkmenistan and Kyrgyzstan) 5 6 (&5.8& (4379258.43 .7 .3 76& 1 4114 ) (49386. 7 .8- & then Malta and population (Turkey Tajikistan Uzbekistan 1Turkmenistan and Kyrgyzstan) 2& 46.8 971.2 then Malta and some Nordic countries (Iceland Norway). The Republic of Moldova (19.2 l) 54591&8.43 countries (Iceland Norway). some Nordic 960 & .0.78&3 0.78&3 9602 3.78&3 &3) 6 78&3 8- 3 &18& &3) has the highest consumption followed by the 742 46).( (49386. 7 ( 1&3) 46 & The Republic of Moldova (19.2 l) has the Czech Republic (16.5 l) Hungary (16.3 l) - 59 1.( 4 41)4 & 1 -&7 highest consumption followed by the 8- the Russian Federation (15.7 l) Estonia -. - 78 (4379258.43 4114 ) 8- Czech Republic (16.5 l) Hungary (16.3 l) (15.6 l) and Ukraine (15.6 l). (- 59 1.( 93 &6 the Russian Federation 1(15.7 l) Estonia 1 8- l) and Ukraine (15.6 l). 1 977.&3 ) 6&8.43 7843.& (15.6 In many countries of Europe and Central 1 &3) 06&.3 1 Asia many contries of Europe and Central In the APC in 2001 2005 was high but stable. Some in 2001 2005 was high countries Asia the (49386. 7 4 9645 &3) 386&1 3 2&3 APC (Norway Finland Cyprus Estonia but stable. A quarter of countries -. 7.& 8- .3 &7 Slovenia the former YugoslavEstonia Republic (Norway Finland Cyprus 98 78& 1 42 (49386. 7 of Macedonia Lithuania Yugoslav Republic Armenia Slovenia the Former 5697 7843.& 46 & .31&3) Azerbaijan Uzbekistan Poland Albania of14 3.& 8- 462 6 %9 471& 59 1.( Macedonia Lithuania Armenia and Kazakhstan) show a trend of Albania Azerbaijan Uzbekistan Poland 4 &( )43.& .8-9&3.& 62 3.& increasing APC. and Kazakhstan) show a trend of 1 &3.& 6 &. &3 0.78&3 41&3) increasing APC. 7-4 & 86 3) 4 &3) & &0-78&3 .3(6 &7.3 Alcohol Consumption Types of Consumed Alcohol Alcohol consumption types of consumed alcohol Beverages 4379258.43 5 7 4 patterns 1(4-41 and Trends drinking Patterns beverages and trends in in Drinking 43792 ) 1(4-41 Traffic 6& 7 &3) 6 3)7 .3 crashes are only one part of injuries and deaths because of alcohol-related 6.30.3 &88 637 2002). From 2006 to 2010 drivers in Slovenia with a & 642 84 )6. 67 .3 14 3.& .8- BAC above 0.05% were involved in & 4 5 6 ( 38 6 10.1 12.6% of all traffic accidents.&11 86& .( &((.) 387 4 6 .3 64&) (6&7- 7 .8- &8&1.8. 7 However in road crashes with fatalities the .3 41 ) .3 5 6 ( 38 4 percentage of alcohol-impaired drivers ranged from 642 to 37.3% (Republic 5 6 ( 38 of 8- 5 6( 38& 4 &1(4-41 .25&.6 ) )6. 67 6&3 ) 30.3% 5 6 ( 38 84 It is not onlyPolice). drink driving but also drink walking drink cycling and drink riding which can Slovenia 4 14 3.& 41.( 59 1.( lead to road fatalities. A study in five European countries (Slovenia Hungary Estonia It is not only drink driving but also 2001 43 per drink pedestrians 40 per cent of Poland and Slovakia) showed that in drink walking cent ofcycling and drink riding which can 8 .7 348 431 )6.30 )6. .3 98 &174 )6.30 &10.3 )6.30 ( (1.3 &3) )6.30 6.).3 -.(- (&3 lead 38 per fatalities. A study in five per cent countries and 30 per cent of drivers to road cent of motorcyclists 47Europeanof cyclists (Slovenia Hungary Estonia 1 &) 84 64&) &8&1.8. 7 789) .3 . 9645 &3 (49386. 7 14 3.& 93 &6 7843.& Poland and Slovakia) showed that in 2001 43% influence of alcohol (Varga et 38% passengers killed in traffic accidents were under theof pedestrians 40% of drivers al. of 41&3) &3) 14 &0.& 7-4 ) 8-&8 .3 5 6 ( 38 4 5 ) 786.&37 5 6 ( 38 4 )6. 67 motorcyclists 47% of of alcohol intoxication among fatally injured pedestrians was 2002). The average level cyclists and 30% of passengers killed in traffic accidents were 5 6 ( 38 4 24846( (1.787 5 6 ( 38 4 ( (1.787 &3) 5 6 ( 38 4 5&77 3 67 0.11 ) under the influence of alcohol (Varga et al. 2002). The average level of alcohol intoxication higher than in other groups of traffic participants such as drivers motorcyclists cyclists .3 86& .( &((.) 387 6 93) 6 8- .3 19 3( 4 &1(4-41 &6 & 8 &1 - & 6& among fatally Alcohol-impaired pedestrians than other groups are predominantly and passengers.injured pedestrians was higherkilled in road crashes of traffic participants 1 1 4 &1(4-41 .384 .(&8.43 &243 &8&11 .3 96 ) 5 ) 786.&37 &7 -. - 6 8-&3 .3 48- 6 such as drivers motorcyclists cyclists of road accident greater incidence of young men who have a higher level of riskandapassengers. Alcohol-impaired pedestrians 64957 4 86& .( 5&68.(.5&387 79(- &7 )6. 67 24846( (1.787 ( (1.787 &3) 5&77 3 67 killed in road crashes are of survival following road accident a higher level of 2008). injuries and a shorter periodpredominantly youngamen who have(Prijon & Ermenc risk of a 1(4-41 .25&.6 ) 5 ) 786.&37 0.11 ) .3 64&) (6&7- 7 &6 56 )42.3&381 493 2 3 -4 road accident greater incidence of injuries and a shorter period of survival following a -& & -. - 6 1 1 4 6.70 4 & 64&) &((.) 38 6 &8 6 .3(.) 3( 4 .3 96. 7 &3) & 7-468 6 road accident (Prijon & Ermenc 2008). 5 6.4) 4 796 . &1 4114 .3 & 64&) &((.) 38 6. 43 62 3( w www.icap.org e info icap.org e 0 Beer is the most preferred drink in Beer is the most preferred drink in Europe followed by wine and Europe followed by wine and spirits. Beer is traditionally the spirits. Beer is traditionally the most popular drink in Central most popular drink in Central Europe (particularly Czech Europe (particularly Czech Republic Germany Poland and Republic Germany Poland and Austria) and Northern Europe Austria) and Northern Europe (Iceland Netherlands Norway (Iceland Netherlands Norway Finland and Denmark). Its Finland and Denmark). Its popularity is increasing in popularity is increasing in Azerbaijan and Turkey. Azerbaijan and Turkey. Wine is the most consumed Wine is the most consumed alcohol beverage in Italy alcohol beverage in Italy Luxembourg France Portugal Luxembourg France Portugal . Switzerland Greece Croatia and Slovenia. The distinction between wine beer spirits cultures Switzerland Greece Croatia and Slovenia. The distinction between wine beer spirits cultures has been based on male drinking (M kel et al. 2006). European differences in beverage has been based on male drinking (M kel et al. 2006). European differences in beverage preference are diminishing. Furthermore in countries with high wine production young preference are diminishing. Furthermore in countries with high wine production young males under the age of 18 prefer drinking beer whereas young females under the age of 18 males prefer drinking beer whereas young females prefer RTD (ready-to-drink) premixes prefer RTD (ready-to-drink) premixes (Hibell et al. 2012). Today in Spain the most consumed (Hibell et al. 2012). Today in alcohol is beer but in Sweden the beverage in liters of pure alcohol beverage in liters of pureSpain the most consumed alcohol most consumed beverage in alcohol is alcohol is in Sweden the most consumed beverage in liters of pure alcohol is wine liters of pure beer but wine (Anderson & Baumberg 2006). (Anderson & Baumberg 2006). Spirits still constitute the largest proportion of alcohol consumed in Kyrgyzstan Tajikistan Spirits still constitute the largest proportion of alcohol consumed in Georgia Ukraine Bosnia and Herzegovina Kazakhstan Uzbekistan Russian Federation Kyrgyzstan Tajikistan Bosnia and Turkmenistan Israel Slovakia Albania Bulgaria and Belarus. Spirits Estonia Latvia Herzegovina Kazakhstan Uzbekistan Russian Federation Georgia Ukraine Estonia Latvia Turkmenistan Israel in these Albania Bulgaria period from Spirits remained fairly constant in consumption Slovakia countries during theand Belarus. 1997 to remained fairly constant in consumption in these Europe appears to period from 1997 2010. Most of the increase in consumption in Easterncountries during thebe in the form of to 2010. Most of the beer consumption increase in consumption in Eastern Europe appears to be in the form of beer consumption. 42 Table 2. Alcohol Consumption Per Capita (APC) and Distribution of Alcohol Table 2. Alcohol Consumption Per Capita (APC) and Distribution of Alcohol Beverages Consumed by Country Beverages Consumed by Country Country Republic of 7 A Republicof Moldova (the) 0 -74. 1 Moldova Czech 0 -74. CzechRepublic (the) E0.3 Republic Hungary Russian Federation Estonia Ukraine Andorra Romania Slovenia Belarus Croatia Lithuania Portugal Ireland France Denmark United Kingdom of Great Britain 94 0 Kingdom 9 United 492 8 1 and Northern Ireland Poland Slovakia Austria Luxembourg Germany Finland Latvia Bulgaria Spain Armenia Serbia Kazakhstan Switzerland Belgium Greece Italy Azerbaijan Sweden Netherlands (the) Netherlands &30 0 30 7 9 Bosnia and Herzegovina Cyprus The Former Yugoslav Republic 0 -74. 1 .0 94 FYR Macedonia of Macedonia Norway Albania Georgia Iceland Kyrgyzstan Turkmenistan Malta Uzbekistan Tajikistan Turkey Israel Source WHO 2011 APC (liters) 19.2 16.5 16.3 15.7 15.6 15.6 15.5 15.3 15.2 15.1 15.1 15.0 14.6 14.4 13.7 13.4 13.4 13.3 13.3 13.2 13.0 12.8 12.5 12.5 12.4 11.6 11.4 11.1 11.0 10.9 10.8 10.8 10.7 10.6 10.3 10.1 9.6 9.3 8.5 7.8 6.7 6.4 6.3 5.1 4.6 4.3 3.5 3.4 3.4 2.9 Beer 31 57 35 33 34 32 31 39 29 20 37 45 31 53 17 45 43 56 36 53 14 53 46 33 32 45 9 44 27 31 57 24 22 87 39 50 23 35 36 47 33 18 52 16 9 34 20 21 60 39 Wine 36 16 40 1 7 7 44 22 45 9 47 14 55 20 62 39 30 12 15 32 70 27 23 10 22 36 3 22 5 50 37 49 73 12 44 34 4 32 28 31 19 20 28 4 39 28 14 5 5 7 Spirits 33 24 24 63 57 61 25 39 13 43 15 36 10 19 20 16 21 31 49 13 16 20 28 56 45 13 6 34 68 18 6 26 5 1 17 16 73 32 36 20 47 62 19 80 52 33 66 74 35 52 Other 3 1 3 2 1 28 1 5 4 8 1 0 6 2 3 1 1 6 82 1 1 1 1 1 2 1 1 1 1 5 2 w www.icap.org e e info icap.org 0 Drinking patterns gender and age differences in Europe and Central Asia have also been changing however men are still more likely to be drinkers and women more likely to be changing however men more likely tolikely to be drinkers and per occasion likely drink more abstainers. Men are are still more drink large quantities women more and to be abstainers. Men are more likelyadults are more likely than older ageand drinkto drink large often than women. Young to drink large quantities per occasion groups more often than women. Young adults are more likely than older age groups to drink large quantities per occasion and drink more often. quantities per occasion and drink more often. Drinking patterns gender and age differences in Europe and Central Asia have also been The prevalence of abstainers in Europe and Central Asia ranges from 4.5% of adults in Germany to 90.4% in Turkey. The higher prevalence of abstainers per cent of adults in The prevalence of abstainers in Europe and Central Asia ranges from 4.5is found in countries like Bosnia and Herzegovina (82.8%) higher prevalence of abstainers is found in countries Germany to 90.4 per cent in Turkey. TheGeorgia (51%) Kyrgyzstan (50.9%) Kazakhstan like(48.9%) and Herzegovina (82.8 per cent) Georgia (51 per cent) Kyrgyzstan (50.9 per of Bosnia and Israel (47.3%) because of religious reasons. The lowest prevalence abstainers can(48.9 per cent) and Israel (47.3 percountries suchof religious reasons. cent) Kazakhstan be found in relatively traffic-safe cent) because as Germany 4.3% Denmark 5.6% France 8.6% and Norway 10% (WHO 2011). The lowest prevalence of abstainers can of adults are abstainers. Aboutcountries such as In the European Union about 15% be found in relatively traffic-safe 15% of adults drink Germany (4.3 a hazardous way above 20 g (women) or 40 g (men) and day. About per of alcohol in per cent) Denmark (5.6 per cent) France (8.6 per cent) per Norway (10 5% cent) (WHO 2011). women are dependent on alcohol in any one year (Anderson &About men and 1% of In the European Union about 15 per cent of adults are abstainers. 15 Baumberg adults drink alcohol in a hazardous way above 20 g (women) or 40 g (men) per cent of 2006). per day. About 5 per cent of men and 1 per cent of women are dependent on alcohol in any Heavy drinking & Baumberg drinking one year (Andersonis a pattern of 2006). that exceeds some standard of moderate drinking. Episodic heavy drinking is a drinking occasion that includes consumption of at least 60 g of alcohol or a pattern of standard drinks. In common terms moderate drinking. Heavy drinking isfive or more drinking that exceeds some standard ofthis is frequently called binge drinking. There is a lack of data on the prevalence of heavy drinkers in many Episodic heavy drinking is a drinking occasion that includes consumption of at least 60 g countries of the region. of alcohol or five or more standard drinks. In common terms this is frequently called binge drinking. type of alcoholof data on the prevalence of amount of alcohol consumed the It is not the There is a lack beverage but the annual heavy drinkers in many countries of the region. frequency of drinking the amount of alcohol consumed at one occasion and the frequency of heavy drinking that increase the risk of alcohol-related harm including It is not theand injuries due to impaired driving or walking.of alcohol consumed the deaths type of alcohol beverage but the annual amount frequency of drinking the amount of alcohol consumed at one occasion and the Patterns heavy drinking that increase the how alcohol-related harm including frequency ofof drinking score (PDS) reflectsrisk ofpeople drink instead of how much they drink. PDS is measured on a scale from 1 (least deaths and injuries due to impaired driving or walking. risky) to 5 (most risky). The higher the score the higher the rate of road fatalities. Patterns of drinking score (PDS) reflects how people drink instead of how much they PDS data of the countries of Europe and Central Asia are shown in Table 3. At the bottom drink.the table where the countries with higher road death rate are listed there is also a of PDS is measured on a scale from one (least risky) to five (most risky). The higher the score the higher the rate of road fatalities. higher frequency of higher PDS values. This (Figure 6). points to a conclusion that a proper national drinking among young males and young females and increased levels of drunkenness. Concern is growing for underage drinking binge drinking among young males and young In the European School Surveys on Alcohol and females and increased levels of drunkenness. In the European School Surveys on Alcohol Other Drugs (ESPAD) consumption habits and Other Drugs (ESPAD) consumption habits among pupils aged 15 16 have been among pupils aged 15 16 have been compared. According to the 2011 ESPAD nearly 60 per cent of students in 342011 ESPAD nearly compared. According to the countries had consumed at least one glass of alcohol by the age of 13 and 12 per34 countries had consumed 60% of students in cent had been drunk at Source Hibell et al. 2012 that age. In the 1995 survey 29 per cent of youngleast one glass of alcohol by the age of 13 at females reported heavy episodic drinking in 2007 and 2011 this figure was 41 per cent and 38 per had been drunk at that age. In the and 12% cent respectively. Among young males the figures were more constant across the ESPAD waves. drinking in 2007 and 2011 1995 survey 29% of young females reported heavy episodic this figure was 41% and 38% respectively. Among young males the figures were more constant across the ESPAD waves (Figure 6 Hibell et al. 2012). PDS data of the countries of Europe and Central Asia are shown crucial for At the bottom alcohol policy is in Table 3. the improvement of of the table where the countries with higher road death rate are listed there is alsoalcohol-related traffic safety and the reduction of a higher traffic injuries. frequency of higher PDS values. This points to a conclusion that a proper national alcohol policy is crucial for the improvement of traffic safety and the reduction of alcohol-related Concern is growing for underage drinking binge traffic injuries. 44 Safe Roads for All Traffic Participants Tra c Participants Efforts to prevent road crashes involving alcohol and VRUs should stem from the premise that road crashes are predictable and therefore preventable. A greater level of awareness commitment and informed decision-making should be created and also an effective partnership between different sectors (public health transport law enforcement finance). Measures to prevent injuries to pedestrians and other VRUs are presented below (Table 4). International best practice measures to prevent alcohol related road crashes Tableinjuries to pedestrians and other VRUs are presented in Table 4 and VRUs and 4. Examples for Prevention of Road Crashes Involving Alcohol below Crash Phase Pre-crash phase Type of Prevention Primary prevention Description Removal of circumstances that cause injury Examples reducing alcohol use reducing speed (50 km h urban speed limit 30 km h in high pedestrian-activity areas 10 km h in shared zones) traffic-calming measures road design controlled crossing pavements safe and accessible roadways and pedestrian facilities pedestrian bridges pedestrian fencing daytime running lights on all motor vehicles increasing visibility at night carrying flashlights wearing retro-reflective clothing proper street lighting high technical standards for vehicles (ABS ESP) designing smart vehicles improving transit facilities (public transport) educating road users about rules rights and responsibilities addressing distracted driving enforcing proper behavior reduced speed at impact vehicles designed with crashworthiness to protect the occupants and pedestrians use of seat belts helmets child restraints Crash phase Secondary prevention Reducing the severity of injury when a crash occurs Post-crash Tertiary phase prevention Optimal treatment effective first aid to reduce likelihood quick transportation to hospital of fatality and long appropriate treatment and rehabilitation term injury severity as well as rehabilitation w www.icap.org e info icap.org e 0 Main Challenges in Preventing Road Crashes Main Challenges in Preventing Road Crashes Involving Alcohol and Vulnerable Road Users Involving Alcohol and Vulnerable Road Users (VRUs) in the Region (VRUs) in the Region Effective strategies and Effective strategies and interventions can be introduced to prevent or minimize introduced to prevent or minimize alcohol-related harm pricing and taxation regulating the physical availability of taxation regulating the physical availability of alcohol-related harm alcohol (limiting hours and days of sale and raising the minimum drinking or legal raising the minimum drinking or legal alcohol (limiting hours purchase age) modifying the drinking context restrictions on marketing education purchase age) modifying the drinking context restrictions on marketing education and persuasion strategies brief interventions with at-risk drinkers and the treatment and persuasion strategies brief interventions with at-risk drinkers and the treatment of drinkers with alcohol dependence. of drinkers with alcohol dependence. It is important to stress that drinkIt is important to stress that drink driving driving countermeasures are an countermeasures the general strategiesof important part of are an important part the general strategies and interventions to and interventions to reduce alcoholrelated harm. related harm. reduce alcoholEvidence fromEvidence experience in Europe shows that from experience in Europe shows that effective measures to prevent drink effective measures to prevent drink driving driving include breath testing testing include random random breath sobriety sobriety checkpoints low BAC limits ( checkpoints low BAC limits (0.05 per 0.05%) a zero BAC limit for young and cent) a zero BAC limit for young and novice drivers graduated licensing for novice drivers graduated licensing for novice drivers and administrative novice drivers and administrative license license suspension. suspension. Improved laws enhanced Improved laws enhanced awareness enforcement and public brought about by concerned citizens enforcement and public awareness during about by have led to the broughtthe 1980s concerned citizens dramatic 1980s in drinking and during thedeclinehave led to the driving in high-income in drinking and driving dramatic declinecountries around the world (Sweedler et al. 2004). The declines in high-income countries around the world (Sweedler et al. 2004). The declines were about 50% in Great Britain 28% in the Netherlands and 37% in Germany. were about 50Keigan (2002) examined BAC levels of drivers and pedestrians killed Tunbridge and per cent in the United Kingdom of Great Britain and Northern Ireland in28 per cent in the Netherlands and 37 the period of 1979 1999 and noticed that traffic crashes in Great Britain during per cent in Germany. Tunbridge and Keigan (2002) examined BAC levels of drivers and pedestrians killed in traffic crashes in the decreased drink driving led to increased alcohol-related pedestrian accidents. The United Kingdom of Great Britain and Northern Ireland during the period of 1979 1999 proportion of alcohol-affected pedestrians (BAC level over 0.08%) had risen from and noticed that decreased drink driving led to increased alcohol-related from 30% 33% to 39% whereas the proportion of alcohol-affected drivers had fallenpedestrian to around 20%. proportion of alcohol-affected pedestrians (BAC level over 0.08 per accidents. The cent) had risen from 33 per cent to 39 per cent whereas the proportion of alcoholNew trends in drinking patterns especially the prevalenceper episodic heavy affected drivers had fallen from 30 per cent to around 20 of cent. drinking can have an impact both on drink driving and drink walking. There is a need for greater public awareness due to the fact that drinking is a risk not only New trends in drinking patterns especially the prevalence of episodic heavy among users of motor vehicles but also among pedestrians. New road safety drinking can have an impact both on drink driving and drink walking. There is a strategies must be developed for the effective reduction of impaired driving and need for greater public awareness due to the fact that drinking is a risk not only impaired walking. among users of motor vehicles but also among pedestrians. New road safety strategies must be developed for the effective reduction of impaired driving and impaired walking. 46 Table Table 3. Alcohol Consumption and Related Harm European and 3. Alcohol Consumption and Related Harm in 49 in 49 European CountriesAlcohol Alcohol Beverages Consumed by Central Asian Countries Beverages Consumed by Country Country Country Road Deaths per 100 000 Population % AlcoholAffected Road Fatalities % Abstainers PDS APC (liters) Iceland Sweden United Kingdom of Great Britain United Kingdom and Northern Ireland Malta Netherlands Norway Switzerland Germany Denmark Ireland Israel Finland Turkey Cyprus Spain Estonia France Luxembourg Tajikistan Austria Italy Portugal Serbia Slovenia Hungary Czech Republic The Former Yugoslav Republic FYR Macedonia of Macedonia Belgium Bosnia and Herzegovina Lithuania Slovakia Armenia Croatia Latvia Azerbaijan Uzbekistan Bulgaria Ukraine Poland Albania Romania Belarus Netherlands (the) Republic of Moldova Greece Montenegro Georgia Kyrgyzstan Russian Federation (the) Russian Federation Kazakhstan Source WHO 2011 2013 2.4 2.8 3.0 3.6 3.8 4.2 4.2 4.4 4.6 4.7 4.7 5.1 5.3 5.4 5.6 5.8 6.3 6.3 6.4 6.6 6.9 6.9 6.9 6.9 7.4 7.6 7.7 7.8 8.9 9.0 9.4 9.5 9.7 9.7 10.1 10.1 10.3 10.4 10.7 11.0 11.1 12.4 12.6 12.7 15.0 15.4 16.4 18.6 21.1 20 22 19 20 15 17 11 20 11 10 24 43 31 15 31 35 2 6 31 5 36 8.3 14 1 25 3.6 21 8 6 30 10 31 4 3 9 21 8 17 9 30 39 59 8 2 17.6 17.5 14.4 27.3 10.0 13.4 4.3 5.6 25.5 47.3 11.8 90.4 45.0 29.1 8.0 15.1 18.0 47.0 15.3 18.7 17.0 15.8 82.8 19.9 23.0 38.7 42.6 24.2 26.8 44.1 25.8 13.1 21.0 22.0 28.3 51.0 50.9 41.0 48.9 3 3 3 1 1 3 1 1 2 3 2 3 3 1 1 3 1 1 3 1 1 1 3 3 3 3 3 1 3 3 3 2 3 3 3 3 2 5 3 3 3 4 4 2 2 3 5 4 6.3 10.3 13.4 4.3 10.1 7.8 10.9 12.8 13.4 14.4 2.9 12.5 3.4 9.3 11.6 15.6 13.7 13.0 3.4 13.2 10.7 14.6 11.1 15.2 16.3 16.5 8.5 10.8 9.6 15.0 13.3 11.4 15.1 12.5 10.6 3.5 12.4 15.6 13.3 6.7 15.3 15.1 19.2 10.8 6.4 5.1 15.7 11.0 w www.icap.org e info icap.org 0 As part of the United Nations Decade of Action for Road Safety the the Global PlanAction was As part of the United Nations Decade of Action for Road Safety Global Plan of of Action was developed in order to guide countries stakeholders in taking concrete actions on a national and developed in order to guide countries stakeholders in taking concrete actions on a national and local local level. activities are based around five five pillars road safety management safe roads and level. The The activities are based around pillars road safety management safe roads and mobility vehicles safe road users and post-crash response (Table 5). 5). How to identify problems mobility safe safe vehicles safe road users and post-crash response (Table How to identify problems identify experience-based solutions to the problems implement solutions and identify the identify experience-based solutions to the problems implement the the solutions and identify the possible interventions are challenges require dynamic thinking and an an engaged approach possible interventions are challenges that that require dynamic thinking and engaged approach tailored to the individual country. tailored to the individual country. Comprehensive data collection of traffic accidents fatalities and serious injuries allows regular Comprehensive data collection of traffic accidents fatalities and serious injuries allows regular monitoring of global regional and country trends and progress toward meeting targets. The monitoring of global regional and country trends and progress toward meeting targets. The investigation of all crashes with fatalities and serious injuries helps to identify the characteristics of investigation of all crashes with fatalities and serious injuries helps to identify the characteristics of road users the mistakes they make what can be incorporated into subsequent education and road measures to eliminate deficiencies of vehicles roads and infrastructure. users the mistakes they make what can be incorporated into subsequent education and measures to eliminate deficiencies of vehicles roads and infrastructure. The participation of all related sectors in road safety strategies is very important not only because of the produced in Europe and elsewhere have become much safer for car occupants and also Vehicles improved treatment of injured road users but also because of its role in raising awareness of the general population of the harmonized vehicle regulations that have been programs and for pedestrians becauseabout harmful drinking and in carrying out rehabilitation developedfor alcoholrelated traffic offenders. adopted by the World Forum for Harmonization of Vehicle Regulations (WP .29) which promote the design and construction of safer and more environmentally-friendly vehicles. To date over 140 Vehicles produced in Europe and elsewhere have become much safer for car occupants and also vehicle regulations have been developed in areas such as passive safety pollution and energy. The for pedestrians because of the harmonized vehicle regulations that have been developed and regulations are based on detailed for Harmonization of Vehicle RegulationsWP .29) which promote the .29 adopted by the World Forum research and subsequent adoption by (WP members. They are all annexed to and form an integral part ofmore environmentally-friendly Regulations date over 140 design and construction of safer and the 1958 and 1998 Vehicle vehicles. To Agreements. vehicle regulations have been developed in areas such as passive safety pollution and energy. The The participationare all related detailed in road safety subsequent adoption by WP not only because of regulations of based on sectors research and strategies is very important members. They are .29 the improved treatment form an integral users but also because of Vehicle in raising awareness of the of injured road part of the 1958 and 1998 its role Regulations Agreements. all annexed to and general population about harmful drinking and in carrying out rehabilitation programs for alcohol-related traffic offenders. Table 5. Examples of Good Practice or EEffective Interventions According the Table 5. Examples of Good Practice or ective Interventions according to Fivethe Fiveof the WHO DecadeDecade Plan Plan to Pillars Pillars of the WHO Action Action Pillar Road safety management Issue Comprehensive data collection on serious injuries and fatalities Road design to reduce speed and increase safety for VRUs Vehicle design safe fronts for pedestrians Examples of Effective Interventions Sweden Finland investigation of all crashes with fatalities and serious injuries Speed limits (50 30 10 km h) in high pedestrian zones. (No more deaths or injured children near schools ) Implementation of Vehicle Regulations - World Forum of Vehicle Regulations of the Inland Transport Committee (UNECE) Periodic Technical Inspections in place Pedestrian awareness campaigns Be visible Rehabilitation programs for repeat offenders treatment for alcoholdependent persons (pilot studies interlocks) active role of medical doctors in counseling drivers who committed a traffic offense Safe roads and mobility Safe vehicles Safe road users Post-crash response Night-time visibility Rehabilitation for repeat offenders 48 Conclusions Conclusions Countries in Europe and Central Asia have significant differences within the region in road traffic injury rates levels of alcohol consumption high level of alcohol consumption risky patterns of drinking in many countries a growing problem of drink walking and a continued problem of drink driving Eastern especially in the east.Europe . Despite the fact that all countries in the region have drink-drive legislation there is a need for measures and interventions for successful enforcement and capacity building with the goal being to reduce alcohol-related traffic fatalities and injuries especially among VRUs. Governments and other stakeholders should prioritize VRUs and establish and meettargets to reduce alcohol-impaired VRU apply UN Decade targets to reduce alcohol-impaired fatalities improve data collection and analysis on crashes involving VRUs (hospital police) promote evidence-based solutions and evaluation of measures encourage public awareness and discussion before mandatory controls. w www.icap.org e e info icap.org 0 References References Anderson P & Baumberg B. (2006). Alcohol in Europe A public health perspective. London Institute of Alcohol Studies. . Anderson Monitoring Centre for Drugs and Alcohol in Europe A public health perspective. London Drugs Alcohol and Medicines in European P. & Baumberg B. (2006). Drug Addiction (EMCDDA). (2012). Driving Under the Influence of Institute of Alcohol Studies. European Monitoring Centre for DrugsLuxembourg Author. (EMCDDA). (2012). Driving Under the Influence of Drugs Alcohol Europe--findings from the DRUID project. and Drug Addiction and Medicines in Europe--findings from the DRUID project. Luxembourg Author. Hibell B. Guttormsson U. Ahlstrom S. Balakireva O. Bjarnason T. Kokkevi A. et al. (2012). The 2011 ESPAD report among students in 36 European countries. Stockholm Swedish Council for Information on Alcohol and other Drugs. Substance use among students in 36 European countries. Stockholm Swedish Council for Information on Alcohol and other Drugs. M kel P Gmel G. Grittner U. Kuendig H. Kuntsche S. Bloomfield K. et al. (2006). Drinking patterns and their gender differences in . Europe.P. Gmel G. Grittner 41(Suppl. 1) i8 i18. Kuntsche S. Bloomfield K. et al. (2006). Drinking patterns and their gender Alcohol and Alcoholism U. Kuendig H. M kel Hibell B. Guttormsson U. Ahlstrom S. Balakireva O. Bjarnason T. Kokkevi A. et al. (2012). The 2011 ESPAD report Substance use differences in Europe. Alcohol and Alcoholism 41(Suppl. 1) i8 i18. Mitis F. & Sethi D. (2013). European facts and global status report on road safety 2013. Copenhagen WHO Regional Office for Europe. Mitis F. &&Sethi D.B. (2008 May). Influence of alcohol intoxication of report on road safety 2013. Copenhagen ForensicRegional Office Prijon T. Ermenc (2013). European facts and global status pedestrians on injuries in fatal road accidents. In WHO Science for Europe. Supplement Series Proceedings of the 17th International Meeting on Forensic Medicine Alpe-Adria-Pannonia Portoroz Slovenia International Prijon T. & Ermenc B. (2008 May). Influence of alcohol intoxication of pedestrians on injuries in fatal road accidents. In (pp. 33-34). Forensic Science International Supplement Series Proceedings of the 17th International Meeting on Forensic Medicine AlpeAdria-Pannonia Portoroz Slovenia (pp. 33-34). Republic of Slovenia Police. Available http www.policija.si Sweedler B. M. Biecheler M. B. Laurell H. Kroj G. Lerner M. Mathijssen M. P M. et al. (2004). Worldwide trends in alcohol and drug . Republic of Slovenia Police. Available http www.policija.si impaired driving. Traffic Injury Prevention 5(3) 175-184. G. Lerner M. Mathijssen M. P. M. et al. (2004). Worldwide trends in Sweedler B. M. Biecheler M. B. Laurell H. Kroj alcohol and drug impaired driving. Traffic Injury Prevention 5(3) 175-184. R. & Keigan M. (2002 August). The Incidence of Alcohol in Fatally Injured Adult Pedestrians in Great Britain. In Proceedings of the Tunbridge 16th International Conference on Alcohol Drugs and Traffic Safety Montreal Canada (pp. 511-516). Tunbridge R. & Keigan M. (2002 August). The Incidence of Alcohol in Fatally Injured Adult Pedestrians in Great Britain. In Proceedings of the 16th International ConferenceKarlovsek M. (2002 August). The role of alcohol licit andCanada (pp. 511-516). Varga T. Vali M. Wachowiak R. Longauer F. & Zorec on Alcohol Drugs and Traffic Safety Montreal illicit drugs in Eastern Varga T. Vali M. Wachowiak R. Longauer F. & Zorec Karlovsek M. (2002 August). The role of alcohol licit and illicit drugs in Eastern Europe. In Proceedings of the 16th International Conference on Alcohol Drugs and Traffic Safety Montreal World Health Organization Canada (pp. 523-529). (WHO). (2011). Global status report on alcohol and health. Geneva Author. World Health Organization (WHO). (2013). Global status report onreport on alcohol and health. Geneva Author. World Health Organization (WHO). (2011). Global status road safety. Geneva Author. World Health Organization (WHO). T. & Kustrin Samba A. (2002). Presence of alcohol and drugs in road users killed in accidents in (2013). Global status report on road safety. Geneva Author. Zorec Karlovsek M. Kozelj G. Pezdir Zorec Karlovsek M. Kozelj G. Pezdir T. & Kustrin Samba A. (2002). Presence of alcohol and drugs in road users killed in accidents in Slovenia in 2001. Annales de toxicologie analytique 14(3) 282. Slovenia in 2001. Annales de toxicologie analytique 14(3) 282. Europe. In Proceedings of the 16th International Conference on Alcohol Drugs and Traffic Safety Montreal Canada (pp. 523-529). 50 Biography P ro f. M a j da Z o re c K ar l ov s ek Europe Presenter E uro pe Pr ese nter M a j d a issAssistant Professorsfor forensic rmedicine e d i c i n e -toxicology at Majda i A s s i s t a n t P r o f e s o r f o r f o e n s i c m - forensic f o r e n s i c tthei c o l o g y for Forensic imedicine F o r e n s i c m e d i c i n e M e dof Ljubljana.t y o x Institute a t t h e I n s t t u t e f o r Medical Faculty University i c a l F a c u l U n i vareasyoforesearchaincludeealcohol sdrugs s e a rdriving.l She regularly l f L j u b l j n a . H r a r e a o f r e and c h i n c u d e a l c o h o Her e r s i t d r u g s a n dknowledgeS h e experience rtol publich e r k n o w l e d g e a n d d r i v i n g . and r e g u l a r l y e a t e s health issues like alcohol relates her e x p edrug c e t o p u b l i c hand taddiction road traffichcrashes d r u gworkplace and r i e n use and abuse e a l h i s s u e s l i k e a l c o o l a n d and u s e a n d a bShe isathe author t i onumeroust r a f f i c c r a s h e s a nand o r ap l a c e safety. u s e n d a d d i c of n r o a d public publications d w is k s a f e t y. S h e i sin h e a u awareness campaignsu b l iroadi o n s p u bSlovenia. i s spokesperson t many t h o r o f n u m e r o u s p on c a t safety in l i c a n d a s po k es p er s on i n m a n y awa r en e s s c a m pa i gn s on r o ad s af e ty i n Sl ove nia . Ms Majda Zorec Karlovsek Click to download the full presentation Click to download the full Ms Karlovsek presentation for 2013 P r o f . K a r l o v s e k provided for the the 2013 United Nations Global Road safety Week United Nations Global Road Safety Week w www.icap.org e info icap.org 0 DrivingUnder the Influence of Alcohol Driving Under the Influence of Alcohol in Israel and the Middle East Dangers in Israel and the Middle East Dangers Problems and (New) Solutions Problems and (New) Solutions Drinking and driving is dangerous no reasonable person could entertain a serious argument against this assertion. Nevertheless difficulties in assessing the exact degree of danger e.g. measuring the number of people killed in Road Traffic Accidents (RTAs) when at least one of the drivers is under the influence of alcohol (DUI) are evident even in highly developed countries. Laurell (2007) of the Swedish National Road Authority formulated an impressive list of misunderstandings that can lead to such difficulties. These included the changing of BAC limits inconsistencies such as accidents when not all involved drivers are tested and cover-ups such as when for example in Germany drivers who crash without involving another moving vehicle are not tested. In many other parts of the world making a proper assessment of this problem is even more difficult. Mr Michael Cale Michael H. Cale CogniTo ltd. Effective Traffic Psychology c Email c a l e . m i c h a e l g m a i l . c o m Middle East - Israel In some Middle Eastern countries a failure to document driving under the influence can be attributed to the fact that alcohol is by and large not permitted. In many Islamic countries in the Middle East alcohol is prohibited for religious reasons. Consequently driving under the influence does not appear in official police records in these countries. Despite such prohibition estimates of alcohol consumption have been published for several of these countries. According to The Economist ( Islam and alcohol Tipsy taboo August 2012 see also WHO [2004]) the average annual alcohol consumption level per adult is estimated to be 2.23 l in Lebanon 2.0 l in Israel 1.25 l in Turkey 1.02 l in Iran 0.37 l in Egypt 0.25 l in Saudi Arabia and 0.11 l in Libya. As mentioned above there still is no reliable documentation that demonstrates how these numbers relate to levels of impaired driving. Rare reports on impaired driving in the Middle East do exist such as an article that appeared on the BBC website on June 19 2012 (Pourparsa and Ahmadi [2012]) Another concern raised by health officials and the police is a rise in drinkdriving. In 2011-2012 Iran s police withdrew the driving licences of 829 drivers including 43 women who had failed to pass alcohol and drug tests. 52 Most recently alcohol tests taken from drivers in Tehran in the period of 20 April Most recently alcohol tests taken from drivers in Tehran in the period of 20 AprilMay showed that 26% of them them were . . . 20 May showed that 26 per cent of were drunk.drunk. . . . A further major concern of Iranian health officials is a general unwillingness among relevant authorities to admit to such problems. As the consumption of alcoholic drinks is haram [religiously forbidden] some officials are just trying to conceal the facts. . . . But the lack of data on alcohol consumption and consumers is itself a serious threat wrote a conservative news website on 15 May. Even the chief of police AhmadiMoqaddam has criticised the attempts to conceal data on alcohol abuse. There have always been attempts to conceal alcohol-related problems in the country but alcohol consumption and an increase in alcoholism are facts . In a paper I had the honor of preparing for the United Nations Economic Commission for Europe (UNECE) two years ago (Cale [in press]) a chapter is dedicated to the Israeli experience which I believe can in many ways be referenced as a good practice. In a small country of no more than 7 million citizens you can find a significant number of homogeneous groups with divergent attitudes belief number of homogeneous groups with divergent attitudes belief systems and cultural characteristics relevant to safe driving in general Muslim and cultural characteristics relevant to safe driving in general Muslim and Christian Arabs orthodox ultra-orthodox and secular Jews and since the late Arabs orthodox ultra-orthodox secular Jews and since the late 1980s a huge group of immigrants from the former Soviet Union (FSU). Reliably group of immigrants from the former Soviet Union (FSU). Reliably collecting and publishing data is considered vital although political correctness publishing data is considered vital although political correctness frequently prevents authorities from reporting differences between ethnic groups. I I prevents authorities from reporting differences between ethnic groups. shall begin with a general overview. a general overview. Legal restrictions and regulations in Israel are similar to those of many Western countries. Experienced drivers are allowed behind the wheel if they have BACs of less than 0.05 g dl. For drivers with less than two years of experience or who are younger than 21 there is zero tolerance (i.e. a BAC limit of 0.00). Drivers caught driving under the influence of alcohol can expect to be fined to have their licenses revoked for extensive periods of time or to be referred for clinical evaluation. Young drivers who are caught will also have their (or more likely their parents ) cars confiscated. In extreme w www.icap.org e info icap.org 0 cases drivers who cause serious accidents while DUI may even have to serve time in jail. Is the law enforced The number of breathalyser tests performed by Israeli police is on the rise. According to data published by the European Transport Safety Council (ETSC) an average of 4 out of every 1 000 citizens were subjected to the test in 2006. This number rose to 24 in 2007 and 69 in 2008 depicting a 17-fold rise in a three-year period and this figure is yet to be considered sufficient. The trend of investing in sobriety tests at sensitive times (mainly over the weekend) is important because as shown in the ETSC data there is a highly significant negative correlation (r .576) between the likelihood that drivers will be randomly tested for alcohol and the proportion of drivers found DUI. In other words the more routine testing for drunk driving becomes the fewer drunk drivers there are. To put the seriousness of DUI in Israel into perspective police statistics for 2011 show that there were twice as many fatalities and five times as many injuries attributed to DUI than to driving above the legal speed limit. On the other hand non-compliance with red traffic lights killed three times more and injured nine times more people than incidents involving those driving under the influence of alcohol. From this comparison we can learn that in Israel driving under the influence of alcohol is certainly a serious issue but not the most serious one. According to the Central Bureau of Statistics (2012) the number of alcohol-related accidents is in decline and has returned to 1999 levels now accounting for 3 per cent of serious accidents. This might be an artifact because not all drivers who are involved in accidents are checked for alcohol indeed publications based on medical emergency data indicate that between 8 per cent and 17 per cent of road fatalities are alcohol related (see Soffer et al. [2006] Siman-Tov & Peleg [2010] Tomer-Fishmann [2009]). The latter numbers appear more likely to be true given that the general level of alcohol consumption in Israel is definitely on the rise. On the downside of the reality of DUI-related law enforcement interlock technology is not applied in spite of sufficient available evidence of its efficacy (Elder et al. 54 [2011]). Judges do not have the option of referring offenders to serious professional interventions as is common for instance in Germanspeaking countries. This is especially frustrating in light of the fact that many DUI drivers are repeat offenders (Shinar [2007] Factor Mahalel and Yair [2008]) and are frequently caught performing one of a wider group of dangerous and illegal driving behaviors. In addition free bus services from the pub and party areas to the residential suburbs are offered to young people on Friday and Saturday nights to encourage them to leave their cars at home. The Israeli Road Safety Authority (RSA) has over the years made many attempts to promote the designated driver model its acceptance level is still far from satisfying (see Cale [in press] for a general discussion on the effectiveness of this model). This information aside how many Israelis actually do drink and drive In 2012 the Israeli RSA published data from a survey showing that 30 per cent of the total driving population including 41 per cent of drivers aged 20-29 admitted to having driven under the influence of alcohol at least once in the past year (Goldwag [2012] Hili Zaig [2012]). One out of five drivers actually drank so much that they were over the legal limit and incapable of safe driving. This demonstrates that drivers are not able to assess how much they can actually drink and that either a zero BAC limit or tighter police surveillance is needed. As shown in my original paper (Cale [ in press]) looking at different group tendencies is justified in Israel Arab people constitute a mere 11 per cent of license holders but make up 26 per cent of road traffic accident fatalities. A number of reasons explaining these data were proposed in the original paper including the tendency to disregard rules and regulations especially when driving on one s home ground. Passing a rigorous theory test is necessary for obtaining a driving license in Israel so we may assume that traffic laws and regulations are equally familiar to all groups of drivers. Studies like those by Jaffe et al. (2009) Soffer et al. (2006) and Siman-Tov and Peleg (2010) all clearly demonstrate that Arab drivers young drivers and men are especially at risk of being injured in alcoholrelated traffic accidents. Soffer et al. (2006) showed that in Israel Arab people are four times more likely to be hurt in alcohol-related crashes than Jewish people in comparison young drivers (age 44) are eight times more likely than older ones and men are nine times more likely than women to be hurt in alcohol-related accidents. Few serious attempts have been made to explain differences in alcohol consumption and driving between groups with the majority of studies not being recent ones. Most prominent are the publications w www.icap.org e info icap.org 0 of Shoshana Weiss (1996 2002 2008 Weiss & Moore [1999]) and of Schiff Rahav and Teichmann (2005) who explain the differences in alcohol consumption (including in the context of driving) for Jewish Arab Druze and FSU young people. According to Weiss (1996) young Arab and Druze drivers tended to be less knowledgeable of both the BAC limit and youth vulnerability. Young Arab people tended to exaggerate the legal amount of drinks that can be consumed before driving to believe in common cultural myths more than Jewish people and to also get lower scores in tests centred around the main effects that alcohol can have on driving skills. However they tended to be more aware than young Jewish people about youth vulnerability. The youths who participated in Weiss s initial survey can be considered to be secular. They remain dedicated to their ethnic group but mingle with Jewish groups and go out to party and have a good time with their Jewish peers. Other authors (e.g. Neumark et al. [2001]) have concluded that being religious be it Muslim or Jewish indeed protects people from the temptations and risks of DUI but that the minute they leave the religious role and compete for a place in secular society on other terms they are easily drawn into the dangers of DUI. As the data published by Soffer et al. (2006) and Hili Zaig (2012) clearly show DUI in Israel is indeed mainly a problem related to younger male drivers who also have less driving experience and are under extreme social pressures (see also SelaShayovitz [2008]). Drinking and driving can be interpreted to a great extent in terms of social pressures and expectancies both in young Arab and Jewish groups in Israel with young people being forced into negative behavior to to survive socially. with young people being forced into negative behaviour survive socially. DUI in Israel is much less of an issue for middle-aged and older drivers ultraorthodox Jews traditional Muslim people and women. Studies have shown that these groups are at a high risk for other offenses however. For example ultraorthodox Jewish drivers and their children tend to be at a high risk of severe injury 56 because they refrain from using seat belts and adult Muslim people tend to be at a high risk of disregarding high risk of disregarding traffic rules of driving aimlessly and of paying insufficient of driving aimlessly paying insufficient attention to traffic. There appear to be two exceptions to these rules middle-aged secular Jewish drivers after celebrations such as weddings or bar mitzvahs who refuse to let someone else be a designated driver and drivers from FSU-related groups who tend to drink more frequently than members of other groups and are convinced they can function with large quantities of alcohol in their bloodstreams. Interestingly there are no data from Israel showing a rise in the prevalence of intoxicated pedestrians being hurt in accidents as has been observed in Western countries (K. Elsig personal communication [2013]). At this point it is important to remember that human behavior is not totally controllable through threats or punishment. We do what we do for a multitude of reasons many of which are outside of conscious awareness (see Kahneman [2011]) as I have explained elsewhere (Cale (in press). For example a young driver might be explained elsewhere (Cale in example a young driver might be slightly deterred by the risk of being fined or punished nevertheless they might also fear social rejection suffer from negative self-esteem or experience public ridicule all of which might increase insecurities even more than the threat of being fined. In such a case the threat of punitive actions might actually backfire (i.e. being caught by the police might allow them to appear like a hero in the eyes of their friends) and another angle that is tailored to a specific group might be more effective. The decision (D) whether to drive under the influence of alcohol is the outcome of all likelihoods (P) that something (subjectively) positive will occur times the value (V) an individual attaches to this occurrence minus the sum of negative outcomes an individual subjectively predicts times the importance or value attached to this occurrence. In other words decisions reflect what seems most worthwhile to the person. According to Kahneman (2011) this decision will be made spontaneously based on the ego-preserving assumption WYSIATI ( what you see is all there is ). The model might appear simplistic or obvious. The advantage of the model is that it is practical. Rare negative occurrences (e.g. being stopped by the police) can be made more likely or their price can be made more relevant for the driver. Positive feedback for adaptive behaviors can increase the likelihood that young drivers will refrain from DUI. Such is the basis for the Guardian Angels project which ran very successfully in Israel among the target group of young secular drivers. We can easily manipulate tools according to which values are reassessed. In short cultural and religious differences can be leveraged to reduce the number of people who will drink and drive. w www.icap.org e info icap.org 0 According to this model society should make the driver a quasi-personal offer so tempting that he or she will refrain from dangerous behaviors such as drinking and driving. To reach this goal influence should not come from above but instead from relevant peers. Based on the information presented above I recommend the following Increase the number of (random) sobriety checks at sensitive times and locations to a number at which drivers will feel it is likely they will be tested Use black boxes that can detect dangerous driving behavior. Initially these boxes can be connected to interlock and will provide real-time feedback about driving style and dangers. The data from these black boxes can serve as the basis for intervention and training procedures Develop projects like the Guardian Angels project as a social tool to change social pressures and attitudes and make dangerous driving unacceptable Increase police efforts along with a general zero-tolerance policy Empower judges to refer problematic drivers to culturally and socially relevant interventions Support different community and religious groups that can influence drivers who are at risk of driving under the influence of alcohol. References Cale M. (in press). Cultural differences and traffic accidents. United Nations Economic Commission for Europe. Central Bureau of Statistics. (2012). Road accidents with casualties. Jerusalem Author. Elder R. W. Voas R. Beirness D. Shults R. A. Sleet D. A. Nichols J. L. et al. (2011). Effectiveness of ignition interlocks for preventing alcohol-impaired driving and alcohol-related crashes A community guide systematic review. American Journal of Preventive Medicine 40(3) 362-376. Factor R. Kawachi I. & Williams D. R. (2011). Understanding high-risk behavior among non-dominant minorities A social resistance framework. Social Science & Medicine 73(9) 1292-1301. Factor R. Mahalel D. & Yair G. (2008). Inter-group differences in road-traffic crash involvement. Accident Analysis and Prevention 40(6) 2000-2007. Goldwag R. (2012). Driving under the influence of alcohol 2011. Jerusalem Israel National Road Safety Authority. Hili Zaig R. (2012). Driving under the influence of alcohol (Tazpit 14). Jerusalem Israel National Road Safety Authority. Islam and alcohol Tipsy taboo. (2012 August 18). The Economist. Available http www.economist.com node 21560543 Jaffe D. H. Savitsky B. Zaistev K. Hiss J. & Peleg K. (2009). Alcohol and driver fatalities in Israel An examination of the current problem. The Israel Medical Association Journal 11 725-729. Kahneman D. (2011). Thinking fast and slow. London Penguin. Laurell H. (2007). Alcohol regulation in Sweden and the European Union Effects on road safety. In K. Stewart (Ed.) Traffic safety and alcohol regulation A symposium June 5-6 Irvine California (Transportation Research Circular E-C123 pp. 60-72). Washington DC Transportation Research Board. Available http onlinepubs.trb.org onlinepubs circulars ec123.pdf Neumark Y. D. Rahav G. Teichman M. & Hasin D. (2001). Alcohol drinking patterns among Jewish and Arab men and women in Israel. Journal of Studies on Alcohol 62(4) 443-447. Pourparsa P & Ahmadi A. (2012 June 19). Iran s hidden alcoholism problem. BBC News Online. Retrieved June 12 2013 . from http www.bbc.co.uk news world-middle-east-18504268 58 Biography MMrM i c h a e l C a l e r. Michael Cale Middle a s t P Presenter M i d d l e E East r e s e n t e r M i c h ae l Ca l e i s an i n ter n a tio n al ly r ec o g ni z ed pr o f es s io n a l i n th e f i el d o MrrMichaelsCale o l o g yinternationallyi recognizednprofessionalvin lthe ifield of traffic f t a f f i c p y c h is an . H i s a c t i v i t e s h a v e i c l u d e d d e e o p n g psychology.o o l sactivitieso j e c t s f o r y o u n g d r i v e r s i n t e r v etools viar o g r a m s s c r e e n i n g t His v i a p r have included developing screening n t i o n p projects for young drivers intervention programs for professional drivers o developing f o r p r o f e s s i o n a l d r i v e r s t o d e v e l o p i n g s i m u l a t o r t e c h n o ltog y f o r s a f e t y simulator a n d a d a p tforgsafetys t o h e l pand c i d e n t v i tools s . help accident victims. r e s e a r c h technology i n t o o l research a c adapting c t i m to Lately Mr C a prepared a d a p for UNECE N which he analyzed a n effects t L a t e l y M r.Calel e p r e p a r epaper a p e r f o r Uin E C E i n w h i c h h e the a l y z e dofh e cultural differences d f e r e crashes r o the effectiveness t intervention programs. e f f e c t s o f c u l t u r a l oni froad n c e s o nanda d c r a s h e s a n dofh e e f f e c t i v e n e s s o f i n ter v en ti on p ro gr a ms. Click to download the full presentation Click to download the full Mr Michael Cale provided for the 2013 Michael Cale presentation for the 2013 United Nations Global Road safety Week United Nations Global Road Safety Week Rattner A. Yagil D. & Pedahzur A. (2001). Not bound by the law Legal disobedience in Israeli society. Behavioral Sciences and the Law 19(2) 265-283. Schiff M. Rahav G. & Teichman M. (2005). Israel 2000 Immigration and gender differences in alcohol consumption. The American Journal on Addictions 14(3) 234-247. Sela-Shayovitz R. (2008). Young drivers perceptions of peer pressure driving under the influence of alcohol and drugs and involvement in road accidents. Criminal Justice Studies 21(1) 3-14. Shinar D. (2007). Traffic safety and human behavior. Oxford Elsevier. Siman-Tov M. & Peleg K. (2010). A non-biased evaluation of blood alcohol concentrations in drivers. Injury Prevention 16 A120-A121. Soffer D. Zmora O. Klausner J. B. Szold O. Givon A. Halpern P et al. (2006). Alcohol use among trauma victims admitted . to a level 1 trauma center in Israel. The Israel Medical Association Journal 8(2) 98-102. Tomer-Fishmann T. (2009). Alcohol and driving in Israel. Jerusalem Israel National Road Safety Authority. Weiss S. (1996). What do Israeli Jewish and Arab adolescents know about drinking and driving Accident Analysis and Prevention 28(6) 765-769. Weiss S. (2002). Review of drinking patterns or rural Arab and Jewish Youth in the North of Israel. Substance Use and Misuse 37(5 7) 663-686. Weiss S. (2008). Alcohol use and problems among immigrants from the former Soviet Union in Israel. Substance Abuse 29(4) 5-17. Weiss S. & Moore M. (1999). Cultural differences in the perception of magazine alcohol advertisements by Israeli Jewish Moslem Druze and Christian high school students. Drug and Alcohol Dependence 26(2) 209-215. World Health Organization (WHO). (2004). Global status report on alcohol 2004. Geneva Author. w www.icap.org e info icap.org 0 E x c e r p from m t h e S y m o s u u Excerptst s from the S y m pp ois imm Excerpts f r o the Symposium D iisscc u s i o n Discussion o n D usssi The following excerpts reflect the verbatim unedited comments of the hosts presenters and participants of the symposium. C o m m e n t f r o m p a r t i c i p a n t f r o m Z a m b i a s Pe r m a n e n t M i s s i o n t o t h e U N Comment from participant from when we Permanent Mission to the UN Comment from participant from Zambia s Permanent Mission to the UN We lack a lot of data in Africa evenZambia s are giving you the high trends that s not even the whole picture it s really the tip of the iceberg. It would be really key and very important not We for a lot of data in trends in what s happening but also to trends that s not we ve onlylack us to monitor Africa even when we are giving you the high monitor how fareven themoved whole picture it s the the tip that iceberg. It in action. toward getting toreallytargetsof the we ve set would be really key and very important not only for us to monitor trends in what s happening but also to monitor how far we ve moved toward getting to the law that prevents in action. If we want to have atargets that we ve setpedestrians from drinking and walking around we need Parliament to enforce that law. Parliamentarians will look at the electorates and say... Why If we many have a have we lost because they are drinking The data will help we need How want topeople law that prevents pedestrians from drunk and walking around us in many many Parliament to enforce that law. how we are moving toward electorates and it will be a ways. It will help us monitor Parliamentarians will look at thethe targets and say... Why tool that we How many people have we lost help us. use to lobby governments to because they are drunk The data will help us in many many ways. It will help us monitor how we are moving toward the targets and it will be a tool that we use to lobby governments to help us. Response from Dr Wilson s o n O Associate Professor and Dean R e s p o n s e f r o m D r. W i lOdero d e r o A s s o c i a t e PandeDean a n d D e a n Response from Mr Wilson Odero Associate Professor r o f s s o r School of Public Health Moi University Kenya S c h o o lof Public lHealth aMoi University vKenya K e n y a School o f P u b i c H e l t h M o i U n i e r s i t y I think this is a critical area where partners can support capacity building. There are systems that exist which have been used elsewhere why are they not being used in our continent In South Africa we have established a system over the past 10 years. It is working but we are not seeing the effect in terms of reductions. Data collection is critical to supporting enforcement and monitoring how we are doing. We also must remember that the collection is not just made by the police. It is by the researchers by the local authorities and by a large spectrum of people but it cannot be done without an institution to collect it. Data collection is critical to supporting enforcement and monitoring how we are doing. We also must remember that the collection is not just made by the police. It is by the researchers by the local authorities and by a large spectrum of people but it cannot be done without an institution to collect it. Dr. Wilson Odero Mr Wilson Odero Questions and responses have been edited for brevity. 60 R e s p o n s e f r o m Ms E v a M o l n a r D i r e c t o r U N E C E Tr a n s p o r t Response from M s . Eva Molnar Director UNECE Transport Division Response D i v i s i o n from Ms Eva Molnar Director UNECE Transport Division I would like to point out that what is needed is a proper national statistics association with all of the proper functioning....You can have targets if you have data if you know from where to where you would like to get. I am a bit disappointed that when we talk so much about road safety we tend to move away from this base. We need reforms. We need economic reforms in all areas of society reform of the national statistics system reform of the transport system and even more reform in the health system. There are methodologies available. If there is a political will within a country and there is a well-designed strategy how the country wants to develop then capacity building will help. If it is not there capacity building is not helping. Also we should bear in mind that what we need is not only good national statistics but a good road safety data bank. The road safety data bank is not there to just monitor but to help decide on future investments because we learn from the road safety data bank what are the most critical spots on our network and what changes are needed. We need reforms. We need economic reforms in all areas of society reform of We need reforms. We need economic reforms in all areas of society reform of the nationalnational We need economic reformsthe all areas of society reform of the statistics system reform of the transport system and and We need reforms. statistics system reform of in transport system even more reform in the the health system. even morereform inhealth system. Ms. Eva Molnar the national statistics system reform of the transport system and even morereform in the health system. Ms Eva Molnar w www.icap.org e info icap.org e 0 Question raised by b y M s E v a M Questionn r a i s ebyMs Eva .Molnar o l n a r Q u e s t i o raised d Ms Eva Molnar I would like to raise two questions. One is to a colleague from Slovenia Majda Zorec Karlovsek. You had slide that showed that Slovenia Majda Zorec Karlovsek. You had aaslide that showed that there are a lot of fatal injuries in Slovakia due to the consumption of alcohol. I wonder do you have information why Slovakia is standing out from other European countries. Michael Cale you had lots of interesting messages. One of your messages was about the black box. I wonder if you can speak more to that R e s p o n s from m Majda Zorec Z o r e c K r o v s e k F o r e n s i c l lov sek Response e f r o Ms P r o f . M a j d a Karlovsek aForensic Toxicologist To x i c o l o g i s t Euro p Europee I do not have detailed information on what has happened in Slovakia but perhaps Slovakia is also one country that is a transition country. There are some problems also about too much alcohol consumption but maybe there is also some type of data collection. It is also possible that there are changes from year to year even the year of data collection may have been in some way unique. M M chae Ca e R e s p o n s e f r o m M rr. M iic h a e ll C a lle Psychologist c h o l o g East i d d l e E a s t Response from Mr Michael Cale Traffic Tr a f f i c P s y Middle i s t M I d like to answer two questions. First the question that the representative from Zambia asked. I research I publish I am in favor of data. I just want to warn you not to use data collection as a way not to make a real change because the people have the right to stay alive. I see in Israel every year the studies show that in Arab villages more people are killed in road accidents including things like running over children from the family so there is a limit to how often you can publish it and make models and so on. The child in the Arab village has the same right to stay alive as my child. You must do research but you must also go and make the changes. The child who has to cross this terrible road to get to his school has the right to stay alive. Now let s make sure that we ensure the right and we have tools to do it. The second answer deals with my experience in black boxes that come from two different areas. One is that I deal with a lot of young drivers who have ADHD attention deficit disorder. They are involved between four and six times in serious car accidents compared to their age norms. It is an attention problem it is not a psychological problem. One of the things we do with them to try to help them is give them a black box in the car. They come back in the evening and their parents get an SMS if they are driving erratically. There are a small group of people who have repeatedly been caught with alcohol in their blood who also are repeatedly caught speeding so maybe it is justified that Big Brother put an eye on them and protects the child crossing the road. You must do research but you must also go and make the changes. The child who has You must do research but you must also go and make the changes. The child who to cross this terrible road road to get to his school has the right to stayNow let s make has to cross this terrible to get to his school has the right to stay alive. alive. Now let s sure that we ensure the right and we have tools have tools Mr. do it. Mr. Michael Cale make sure that we ensure the right and we to do it. to Michael Cale Questions and responses have been edited for brevity. 62 Question from participant i p a n t f r o m I t a l i a of Transport Q u e s t i o n s f r o m p a r t i cfrom Italian Ministryn M i n i s t r y o f Tr a n s p o r t have two is for Mr. Bivans. was very interested in the concept of II have two questions. The first one is for Mr. Bivans. II was very interested in the concept of beneficial drinking and negative drinking. Are there studies published or was it just a sort of societal analysis of a tool to curb drink driving And the second one is for Eric. We were dealing with quite a novel concept impaired pedestrians. In order to carry out alcohol tests on pedestrians do you have a legal provision in the traffic code for drunk pedestrians or was it a trial test Response from Mr Brett r e t t B Senior S e n o r V i c e ICAP R e s p o n s e f r o m M r. BBivans i v a n s Vice iPresident P r e s i d e n t I C A P Thank you for the question in reference to my opening remarks where I referred to drinking patterns. When we look at drinking patterns we see a number of different factors and many of those point to low risk of harm whether it is drinking during a meal or drinking during a social environment where they are protective factors. Religion family values and positive social pressure from friends can lead to positive outcomes and we think of these as beneficial outcomes from the drinking occasion. Negative outcomes where the risks are reinforced are where social behavior reinforces bad behavior such as when young people are encouraging one another to drink more or trivialize riding with those who have already consumed alcohol can lead to increased negative outcomes. have already had consumed alcohol can lead to increased negative outcomes. R e s p o n s e f r o Mr M r. E r i c H o w a r d Response from m Eric Howard Many countries have public intoxication provisions in their legislation. It is more about drunken behavior impacting others than the risk of being killed in a road crash. I think that putting that idea out there like a number of the speakers have today is worthy of consideration particularly if the initial conversation is focused on a very high-end BAC levels where the research shows unequivocally that there is a 15 times greater risk of being killed than a pedestrian under 0.1 [mg ml] if you are above 0.15 [mg ml]. That is a staggering difference in risk. I think the starting point is to get the debate going in many societies about the issue get the conversation going. I am reminded as a person who was involved in a lot of legislative change that legislative change was so much easier when we put messages out to the public for a number of years about certain matters before we sought to make it mandatory. A good example is 120 hours of practice for young drivers. It was promoted for five or six years in Victoria and parents did end up giving supervised practice as part of their learning period before we suggested to the public that it could be made mandatory and the reaction from the public was Yeah that s a good idea. So getting messages out such as intoxicated pedestrians being held accountable for their condition I think we have to start with a conversation. I think the starting point is to getget the debate going in many societies about the I think the starting point is to the debate going in many societies about the issue get the conversation going....I am reminded asas person who was involved issue get the conversation going....I am reminded a a person who was involved in aalot of legislative change that legislative change was so so much easier when we in lot of legislative change that legislative change was much easier when we put messages out to the public for a for a number of years about certain matters put messages out to the public number of years about certain matters before we sought to make make it mandatory.... getting messages out such as before we sought to it mandatory.... getting messages out such as intoxicated pedestrians being held accountable for their condition condition intoxicated pedestrians being held accountable for their I think we have to start haveato start with a conversation. Mr. Eric Howard I think we with conversation. Mr Eric Howard w www.icap.org e info icap.org 0 Comment from participantp a n t r e p r e sthetInternational e r n a t i o n a l R o a d C o m m e n t f r o m p a r t i c i representing e n i n g t h e I n t Road Federation (IRF) F ) Fe de r at i on (I R I would like to echo what was said by the representative from Zambia concerning data its importance and the difficulties....The other point I wanted to raise is about enforcement. I don t think anyone in this room can deny the importance of enforcement and equally of course the importance of having very clear and sharp policy and legislation in place. I realize from listening to this forum today that when we speak about enforcement we only really tend to focus on controlling and punishment. I would like to discuss enforcement under another perspective. The community is at the heart of the road safety issue. I also think that in times when we are seeing shrinking resources to invest in programs think about the impact that the community around you could have in trying to really address this problem of road safety. R e s p o n s from m M r. E r i c H o Response e f r oMr Eric Howard w a r d I would like to make a comment about enforcement and this is in a high-income country setting. In Victoria the level is about 500 tests per 1 000 drivers each year. If you get a falling off around 350 300 the number of drink driving fatalities goes up immediately. It is astonishing. The minute that a very small component of the community think that they can get away with drinking and driving that will do it. And you are quite right you have to have positive messages the community saying the social norm is shifting all of that. The underpinning of change is the strong commitment to broad scale general deterrents and random breath testing. I think in Africa we talked about the need for enforcement. Wilson you saw this as a priority. What can we do as a group What can we push for to try to get enforcement strategically targeted enforcement with research help beside it so it s not just a case of running around catching people drinking in an unlicensed premise What could we recommend R e s p o n s e f r o Mr D r. W i lOdero d e r o Response from m Wilson s o n O I think there are other countries where there have been successful stories. One direction would be to target a particular country for a pilot phase and pair them up with a best practices area. They can take researchers police officers and other people in law enforcement to Victoria for example for a two three-week session to see how it is done. Then they can come back and apply those practices and maybe they need more resources like a breathalyzer and train people how to use it. I think that s what s lacking. We have legislation but the legislation is quiet on how that legislation has been enforced. They They don t have don t have breathalyzers. They don t have the booze buses that they have inin Victoria.think busses that they have Victoria. I I think you must start by partnering individuals and police forces of various countries with those in areas where advancement has been successful....Let s have some volunteers some countries willing to support enforcement in certain countries so that we see a positive change in enforcing existing laws. Questions and responses have been edited for brevity. 64 Comment from m p a r t i c i p a n t o r g a n ithatitrains professional rdrivers i o n a l d r i v e r s C o m m e n t f r o participant organization z a t o n t h a t t r a i n s p o f e s s baseddini n B r u s s eBelgium i u m Brussels l s B e l g base In France there is a new legislation about alcohol for buses and Belgium there is legislation for alcohol for criminals on the road. The justice has the possibility to give an obligation with an alcohol lock on the truck. It s very important to make this legislation.... alcohol is a very important problem on the road. Response e f r oMr M r. M i cCale C a l e R e s p o n s from m Michael h a e l We must be careful that we are talking here about traffic safety and not alcohol scapegoating. For every one person who dies in a car accident about alcohol two or three are killed because of fatigue especially among professional drivers. So if we go to technological solutions only in the direction of alcohol then we are missing the landing strip by a few miles. My suggestion of using a combination of interlock and black box equipment can give very suitable and very controllable and measurable solutions. As for police enforcement I d say that data shows that alcohol is one of the things where more enforcement brings more profit....The number of people caught by speed cameras every year is more or less the same which means it can t really be that effective in changing speeding behavior whereas the breathalyzer tests are very effective. So what I do then is go to the other side of the equation and that s the community-based the value-based that you talked about and it can be effective. I remember a project with a group of Arab men and we didn t come with a message that the police is waiting for you behind a corner. We came with a message that it is important to protect the people in your community and did kind of a youth-based movement from there. I ve done projects where we touch maybe 40 people. You touch 40 people and you can empirically show that you ve affected something like 3 000. They change their behavior when you attack the problem from a positive situation. We note that Prof.Shaw Voon Wong of Malaysia was unable toto travel to the symposium. We note that Mr Shaw Voon Wong of Malaysia was unable travel to the symposium. He offered prepared remarks in thisthis video presentation available here for viewing. He offered prepared remarks in video presentation available here for viewing. w www.icap.org e info icap.org 0 Pledge Our symposium culminated with all participants signing this road safety pledge which we were proud to display on a wall-sized banner at the United Nations 66 We the participants of the symposium Regional perspectives on preventing alcohol-related road crashes involving vulnerable road users are committed to improving road safety. w www.icap.org e info icap.org 0 Conclusion We hope that this e-book has sown the seeds of some new ideas as well as reaffirmed the value of many existing interventions to prevent alcohol-related road crashes involving vulnerable road users in your country or region. However there is still room for improvement and more work that can be pursued to improve road safety globally as well as in the area of drinking and driving. We believe that there are many valuable findings and learnings shared in this e-book including The overall nature of alcohol consumption with the diversity of cultural issues and . issues and settings in each country requires locally appropriate responses to be devised and implemented. Political support is essential for the success of every initiative. The collection and monitoring of data on alcohol-related crashes is also very important. There needs to be better and stricter enforcement of vehicle speed limits and BAC limits for drivers and motorcyclists at all times. UN Member States should set BAC limits in their legislation taking into consideration national circumstances including the option of implementing graduated licensing for novice drivers with zero tolerance for drink driving (WHO Global Strategy to Reduce Harmful Use of Alcohol 2010). A lower BAC limit could also be considered for other vulnerable and high risk road users such as motorcyclists commercial drivers and cyclists. In addition the road safety challenge posed by drunk pedestrians and the appropriate interventions merits further consideration and discussion. Culturally and socially relevant projects and interventions involving or overseen by different community and religious groups to change social pressures and attitudes towards drinking and driving could be explored. Partnership between government agencies and the alcohol industry is also recommended to introduce and promote responsible serving of alcohol and associated regulations for licensed premises. 68 In conclusion the UNECE-ICAP Regional perspectives on preventing alcohol-related road crashes involving vulnerable road users international symposium took place in the second year of the United Nations Decade of Action for Road Safety 2011-2020 and was found to be timely and useful. We are thankful for the symposium participants from more than 20 countries and all regions of the world representing local state and federal governments and non-governmental organizations as well as international agencies. The high level of engagement demonstrated by these individuals groups and their constituencies gives us hope for meaningful progress through international dialogue. We are also grateful for the committed efforts of the authors who contributed to this e-book. Together we will continue working to make a difference for all road users globally. Please join us in this effort Eva Molnar Brett Bivans Director UNECE Transport Division Senior Vice President ICAP w www.icap.org w www.icap.org e info icap.org e info icap.org 0